全髋置换联合应用氨甲环酸是否放置引流比较

Combined tranexamic acid administration in total hip arthroplasty with or without drainage

[目的]探讨全髋关节置换术联合应用氨甲环酸(tranexamic acid,TXA)是否放置引流的临床与检验结果.[方法]2016年12月-2020年12月,在本院拟行单侧初次全髋关节置换的患者142例纳入本前瞻对照研究,采用随机数字表法将患者分为两组.两组患者均按计划施行手术,其中,71例术前与术后静脉应用TXA,术中局部应用TXA,不放置引流(无引流组);另外71例患者仅术中局部应用TXA并放置引流(引流组).比较两组患者临床与血液检验指标.[结果]两组手术时间、手术切口长度比较差异无统计学意义(P>0.05);无引流组术后下地时间、住院时间均显著优于引流组(P<0.05).血液丢失方面,无引流组术中出血量、隐性出血量和总失血量均显著少于引流组(P<0.05).输血率无引流组为2.81%,而引流组为14.08%,差异有统计学意义(P<0.05).术前术后行双下肢动静脉血管彩超,均未发现深静脉血栓形成.末次随访时,两组间VAS评分和Harris评分的差异均无统计学意义(P>0.05).血液检验方面,术后3d,无引流组血红蛋白、红细胞压积显著优于引流组(P<0.05),而两组活化部分凝血酶原时间、凝血酶原时间、纤维蛋白原和D-二聚体的差异均无统计学意义(P>0.05)[结论]在全身与局部联合应用TXA的基础上,单侧初次全髋置换不放置引流安全可行.

[Objective]To explore the clinical and laboratory test results of combined tranexamic acid(TXA)administration in total hip arthroplasty with or without postoperative drainage.[Methods]From December 2016 to December 2020,a total of 142 patients undergoing unilateral primary total hip arthroplasty in our hospital were enrolled in this prospective controlled study.Patients were divided into two groups by random number table method.All patients in both groups underwent surgery as planned.Among them,71 patients received TXA intravenously before and after operation,and TXA locally intraoperatively without drainage placed(the non-drainage group),while the other 71 patients only had intraoperatively local application of TXA with drainage placed(drainage group).The clinical and blood test documents were compared between the two groups.[Results]There were no significant differences in operation time and incision length between the two groups(P>0.05),whereas the non-drainage group proved significantly superior to the drainage group in the time to recover walking postoperatively and hospital stay(P<0.05).Regarding to blood loss,the non-drainage group was significantly superior to the drainage group in terms of intraoperative blood loss,hidden blood loss and total blood loss(P<0.05).The blood transfusion rate was 2.81%in the non-drainage group,whereas 14.08%in the drainage group,which was statistically significant(P<0.05).No symptomatic lower limb thrombosis was found in both groups,and no deep vein thrombosis was detected in both groups by color doppler ultrasound before and after operation.At the latest follow up,there were no significant differences in VAS and Harris scores between the two groups(P>0.05).With respect to blood tests,the non-drainage group proved significantly superior to the drainage group in terms of hemoglobin and hematocrit at 3 days postoperatively(P<0.05),despite of the fact that no significant differences were seem in activated partial prothrombin time,prothrombin time,fibrinogen and D-dimer between the two groups at 3 days postoperatively(P>0.05).[Conclusion]On the basis of systemic and local TXA administration,it is safe and feasible that no drainage is used in the unilateral primary total hip arthroplasty.