局部应用骨蜡和氨甲环酸在股骨头坏死全髋关节置换术中止血作用的比较

Comparison of the Hemostatic Effect of Local Application of Bone Wax and Tranexamic Acid in Total Hip Arthroplasty in Osteonecrosis of the Femoral Head

摘要: 目的：比较骨蜡和氨甲环酸在股骨头坏死患者行单侧首次全髋关节置换术中止血作用的效果。方法：对2014年7月至2016年7月入住临沂市人民医院股骨头专科符合纳入和排除标准的152例需行单侧首次THA的股骨头坏死患者进行回顾性分析。按照骨蜡和氨甲环酸的使用情况将其分为4组，A组：骨蜡和氨甲环酸均未使用；B组：仅使用骨蜡；C组：仅使用氨甲环酸；D组：联合使用骨蜡和氨甲环酸。对术中失血量、术后可见失血量、术后血红蛋白变化、总失血量、输血率、临床效果等指标进行评估。结果：4组患者性别、年龄、BMI、Hb、PLT、PT、APTT、手术时间、术中失血量和术后6月髋关节Harris评分之间差异均无统计学意义(p > 0.05)；在总失血量方面，4组患者比较不全相等，差异具有统计学意义(p < 0.05)，其中B组要明显低于A组，差异具有统计学意义(p < 0.05)，而C组和D组又明显低于B组，差异具有统计学意义(p < 0.05)，C组和D组之间比较差异无统计学意义(p > 0.05)；在术后可见失血量和输血率方面，4组患者比较不全相等，差异具有统计学意义(p < 0.05)，其中A组和B组之间差异无统计学意义(p > 0.05)，C组和D组均明显低于B组，差异具有统计学意义(p < 0.05)。4组之间在并发症和功能恢复方面差异无统计学意义(p > 0.05)。结论：骨蜡或氨甲环酸均能明显减少股骨头坏死患者行单侧首次全髋关节置换术的失血量，但骨蜡的止血效果不如氨甲环酸；联合使用骨蜡和氨甲环酸，止血效果要优于单独使用骨蜡，但并不明显优于单独使用氨甲环酸；骨蜡和氨甲环酸没有增加刀口感染、愈合不良和静脉血栓形成等风险，不影响患者术后功能康复。

Abstract: Objective: To compare and analyze the effectiveness of bone wax and tranexamic acid in reducing the blood loss associated with unilateral primary THA in patients with osteonecrosis of the femoral head. Methods: A retrospective study was carried out to analyze the cases of 152 patients who received primary unilateral THA and satisfied inclusion and exclusion criteria during July 2014 to July 2016 in Linyi City People’s Hospital of the femoral head specialist. The patients were divided into four groups according to the use of bone wax and tranexamic acid. In group A, neither bone wax nor tranexamic acid was used. In group B, bone wax was used while tranexamic acid was not. In group C, tranexamic acid was used while bone wax was not. In group D, bone wax and tranexamic acid were both used topically. The bone wax and tranexamic acid in reducing blood loss in unilateral primary THA were evaluated through assessing the intraoperative blood loss, postop-erative visible blood loss, postoperative hemoglobin change, total blood loss, blood transfusion rate, clinical effects and other indicators. Results: No difference of statistical significance (p > 0. 05) was found among the 4 groups in terms of gender, age, BMI, preoperative Hb, PLT, PT, APTT, operation time, intraoperative blood loss and hip Harris score at 6 months postoperative. The total blood loss of the 4 groups was not all the same; the difference was of statistical significance (p < 0.05). The total blood loss of group B was significantly lower than that of group A; the difference was of statistical significance (p < 0.05). The total blood loss of group C and group D was significantly lower than that of group B; the difference was of statistical significance (p < 0.05). There was no significant difference between group C and group D (p > 0.05). The postoperative visible blood loss and blood transfusion rate of the 4 groups were not all the same; the difference was statistical significance (p < 0.05). There was no significant difference between group A and group B (p > 0.05). The postoperative visible blood loss and blood transfusion rate of group C and group D were significantly lower than those of group B. The difference was statistical significance (p < 0.05); there was no significant difference in complications and functional recovery among the 4 groups (p > 0.05). Conclusion: Bone wax or tranexamic acid can significantly reduce blood loss in patients with osteonecrosis of the femoral head underwent unilateral primary THA, but compared with tranexamic acid, bone wax cannot reduce the blood transfusion rate. The effectiveness of combination of both is better than bone wax alone while not better than that of tranexamic acid alone. Both bone wax and tranexamic acid will not increase the incision infection, healing and ve-nous thrombosis risk, and it does not affect postoperative functional rehabilitation.