化瘀止血方对初次人工全膝关节置换术隐性失血与术后膝关节功能恢复的影响

Effect of Huayu Zhixue Prescription on Hidden Blood Loss and Postoperative Knee Function Recovery of the Knee Joints After Initial Total Knee Arthroplasty

【目的】观察化瘀止血方对中晚期膝骨性关节炎(KOA)患者初次人工全膝关节置换(TKA)术后隐性失血及膝关节功能康复的影响。【方法】将98例中晚期KOA拟行单侧TKA治疗的患者随机分为中药联合组和对照组,每组各49例。2组患者均予以TKA治疗,对照组给予围术期常规使用氨甲环酸和术后常规西药治疗,中药联合组在对照组的基础上,于术后第1天开始给予口服化瘀止血方治疗,疗程为14 d,并给予3个月以上的随访。观察2组患者术前、术后血红蛋白、红细胞计数、膝关节美国特种外科医院(HSS)评分的变化情况,比较2组患者术后血虚症状积分、凝血功能以及术后并发症的差异。【结果】(1)研究过程中,有3例患者失访,最后共有95例患者完成随访,其中对照组为48例,中药联合组为47例,平均随访时间为(1.50±0.23)年。(2)与对照组相比,中药联合组患者在术后1周的平均血红蛋白和红细胞计数均明显升高(P<0.05或P<0.01),且中药联合组在术后1周的平均血虚症状积分明显低于对照组(P<0.01)。(3)与对照组相比,中药联合组在术后1周的平均凝血酶原时间明显延长(P<0.01),平均D-二聚体水平明显降低(P<0.01),但2组患者在术后1周的部分凝血活酶时间比较,差异无统计学意义(P>0.05)。(4)术后1个月和3个月,2组患者的膝关节HSS评分均明显高于术前(P<0.05),术后3个月,2组患者的膝关节HSS评分又均明显高于术后1个月(P<0.05);组间比较,中药联合组在术后1个月和3个月的膝关节HSS评分均明显高于对照组(P<0.01)。(5)中药联合组的术后并发症发生率为2.13%(1/47),明显低于对照组的14.58%(7/48),组间比较,差异有统计学意义(P<0.05)。【结论】化瘀止血方能显著升高初次TKA术后短期血红蛋白及红细胞水平,促进凝血功能恢复,改善患者的整体血虚症状,减少术后隐性失血量,促进术口愈合以及膝关节功能康复,降低术后并发症的发生风险。

Objective To observe the effect of Huayu Zhixue Prescription(a herbal compound prescription mainly with the actions of removing stasis to stop bleeding)on hidden blood loss and functional rehabilitation of the knee joint after initial total knee arthroplasty(TKA)in patients with intermediate-to-advanced knee osteoarthritis(KOA). Methods A total of 98 patients with intermediate-to-advanced KOA undergoing unilateral TKA were randomly divided into the Chinese medicine combination group and the control group,with 49 cases in each group.The control group was treated with tranexamic acid orally during perioperative period and conventional western medicine after operation. On the basis of treatment for the control group,the Chinese medicine combination group was treated with oral administration of Huayu Zhixue Prescription from the first postoperative day. The treatment for the two groups covered a course of 14 days and then a follow-up more than 3 months was conducted. The changes of hemoglobin,red blood cell count and American Hospital for Special Surgery(HSS)scores in the two groups were observed before and after operation. And the difference in blood deficiency symptom scores,coagulation function indicators and postoperative complication incidences after the operation were compared between the two groups.Results (1)During the trial,3 patients were lost to follow up,and finally a total of 95 patients completed the follow-up,including 48 patients in the control group and 47 patients in the Chinese medicine combination group,with a mean follow-up time of(1.50 ± 0.23)years.(2)Compared with the control group,the mean hemoglobin level and red blood cell count of the patients in the Chinese medicine combination group were significantly increased on the first week after operation(P<0.05 or P<0.01),and the mean blood deficiency symptom scores of the Chinese medicine combination group on the first week after operation were significantly lower than those of the control group(P<0.01).(3)Compared with the control group,the mean prothrombin time was significantly prolonged(P<0.01)and the mean D-dimer level was significantly decreased(P<0.01)in the Chinese medicine combination group on the first week after operation, but the difference of activated partial thromboplastin time between the two groups on the first week after operation was not statistically significant(P>0.05).(4)One month and 3 months after operation,the knee HSS scores of patients in both groups were significantly higher than those before operation(P<0.05). And 3 months after operation,the knee HSS scores of patients in both groups were significantly higher than those one month after surgery(P<0.05). The intergroup comparison showed that the knee HSS scores of the Chinese medicine combination group one month and 3 months after operation were significantly higher than those of the control group(P<0.01).(5)The incidence of postoperative complications in the Chinese medicine combination group was 2.13%(1/47),significantly lower than that in the control group(7/48,14.58%),and the difference was statistically significant between the two groups(P<0.05). Conclusion Huayu Zhixue Prescription significantly increases short-term hemoglobin and red blood cell levels after initial TKA,promotes coagulation function recovery,improves overall blood deficiency symptoms of the patients,reduces postoperative hidden blood loss,promotes the healing of the surgical wound and functional rehabilitation of the knee joint,and reduces the risk of postoperative complications.