HJS  >> Vol. 5 No. 4 (October 2016)

    Clinical Comparative Study about Intra-Articular Injection of Tranexamic Acid with Different Drainage Tube Clamping Time after Total Knee Arthroplasty

  • 全文下载: PDF(428KB) HTML   XML   PP.81-88   DOI: 10.12677/HJS.2016.54014  
  • 下载量: 458  浏览量: 714  


潘 飞,张才龙,黄 辉,杨选影,夏长所:青岛大学附属医院关节外科,山东 青岛

全膝关节置换术氨甲环酸关节腔内注射引流管夹闭时间Total Knee Arthroplasty Intra-Articular Injection of Tranexamic Acid Clamping Time of Drainage Tube


[背景] 局部应用氨甲环酸(TXA)降低全膝关节置换术(TKA)后失血已获得临床认可,但TKA术后TXA关节腔内注射联合引流管夹闭时间的系统研究很少。[目的] 研究TKA术后TXA关节腔内注射不同引流管夹闭时间对术后失血量、输血量及并发症等的影响,以选择TKA术后TXA关节腔内注射夹闭引流管的最佳时间。[方法] 对2015年1月至2016年3月入住青岛大学附属医院的152例膝骨关节炎行首次单侧TKA的患者进行回顾分析,152例患者于缝合关节囊后均经注射器向关节腔内注射TXA注射液(50 ml,40 mg/ml)并夹闭引流管,释放止血带前绷带加压包扎膝关节。152例患者根据引流管的夹闭时间随机分为4组(夹闭1 h组、夹闭2 h组、夹闭3 h组、夹闭4 h组),各组38例。计算术中出血量、总失血量、术后可见失血量及隐性失血量,统计术后输血、患肢皮下瘀斑、患肢膝关节肿胀及患肢肌间静脉血栓人数,评估术后6月患肢膝关节HSS评分。[结果] 在总失血量、术后可见失血量、隐性失血量及术后输血率方面,夹闭3 h组、夹闭4 h组明显低于夹闭1 h组、夹闭2 h组,且夹闭2 h组明显低于夹闭1 h组;夹闭4 h组术后患肢皮下瘀斑、患肢膝关节肿胀的发生率显著增加;术后6月膝关节HSS评分,4组患者比较差别无统计学意义。[结论] TKA术后TXA关节腔内注射引流管夹闭3h是最佳选择。

[Background] Topical application of tranexamic acid in reducing blood loss after total knee arth-roplasty is clinically recognized. But systematic studies about intra-articular injection of tranex-amic acid of drainage tube clamping time after total knee arthroplasty are rarely. [Objective] To explore the effects of intra-articular injection of tranexamic acid with different drainage tube clamping time after total knee arthroplasty to postoperative blood loss, blood transfusion and complications. To select the optimal drainage tube clamping time about intra-articular injection of tranexamic acid after total knee arthroplasty. [Methods] Retrospective analysis of 152 patients with knee osteoarthritis admitted to the Affiliated Hospital of Qiingdao University from January 2015 to March 2016. 152 patients were performed primary total knee arthroplasty. Injection of TXA injection (50 ml, 40 mg/ml) into the articular cavity via syringe after suture of joint capsule and clamped drainage tube, then bandage compression knee joint, release tourniquet. 152 patients were randomly divided into 4 groups according to the duration of the closure of the drainage tube (clipping 1 h group, clamping 2 h group, clamping 3 h group, clamping 4 h group), each group included 38 patients. The amount of intraoperative blood loss, total blood loss, postoperative visible blood loss and hidden blood loss was calculated. Postoperative blood transfusion, limb subcutaneous ecchymosis, knee swelling and limb muscular venous thrombosis number were counted. Knee Hospital for Special Surgery score was evaluated at 6 months after replacement. [Results] In terms of total blood loss, postoperative visible blood loss and hidden blood loss, postoperative blood transfusion rate, clamping 3 h group, clamping 4 h group were significantly lower than that of clipping 1 h group, clamping 2 h group, and clamping 2 h group was significantly lower than that of clipping 1 h group. Postoperative limb subcutaneous ecchymosis, knee swelling incidence of clamping 4 h group increased significantly. There was no significant difference in the HSS score between the 4 groups at 6 months postoperatively. [Conclusion] Clamping drainage tube for 3 h is the best choice about intra-articular injection of tranexamic acid after total knee arthroplasty.

潘飞, 张才龙, 黄辉, 杨选影, 夏长所. 全膝关节置换术后氨甲环酸关节腔内注射不同引流管夹闭时间的临床对比研究[J]. 外科, 2016, 5(4): 81-88. http://dx.doi.org/10.12677/HJS.2016.54014


[1] Bierbaum, B.E., Callaghan, J.J., Galante, J.O., et al. (1999) An Analysis of Blood Management in Patients Having a Total Hip or Knee Arthroplasty. Journal of Bone & Joint Surgery American Volume, 81, 2-10.
[2] Bong, M.R., Patel, V., Chang, E., et al. (2004) Risks Associated with Blood Transfusion after Total Knee Arthroplasty. Journal of Arthroplasty, 19, 281-287. http://dx.doi.org/10.1016/j.arth.2003.10.013
[3] Lincoln, S., Koen, R., Escobar, M., et al. (2005) A Provincial Program of Blood Conservation: The Ontario Transfusion Coordinators (ONTraC). Transfusion & Apheresis Science, 33, 343-349.
[4] Goodnough, L.T., Verbrugge, D. and Marcus, R.E. (1995) The Relationship between Hematocrit, Blood Lost, and Blood Transfused in Total Knee Replacement. Implications for Postoperative Blood Salvage and Reinfusion. American Journal of Knee Surgery, 8, 83-87.
[5] Mccormack, P.L. (2012) Tranexamic Acid: A Review of Its Use in the Treatment of Hyperfibrinolysis. Drugs, 72, 585-617. http://dx.doi.org/10.2165/11209070-000000000-00000
[6] Cid, J. and Lozano, M. (2005) Tranexamic Acid Reduces Allogeneic Red Cell Transfusions in Patients Undergoing Total Knee Arthroplasty: Results of a Meta-Analysis of Randomized Controlled Trials. Transfusion, 45, 1302-1307. http://dx.doi.org/10.1111/j.1537-2995.2005.00204.x
[7] Mannucci, P.M. (1998) Hemostatic Drugs. New England Journal of Medicine, 339, 245-253. http://dx.doi.org/10.1056/NEJM199807233390407
[8] Good, L., Peterson, E. and Lisander, B. (2003) Tranexamic Acid Decreases External Blood Loss but Not Hidden Blood Loss in Total Knee Replacement. British Journal of Anaesthesia (BJA), 90, 596-599. http://dx.doi.org/10.1093/bja/aeg111
[9] Ishida, K., Tsumura, N., Kitagawa, A., et al. (2011) Intra-Articular Injection of Tranexamic Acid Reduces Not Only Blood Loss but Also Knee Joint Swelling after Total Knee Arthroplasty. International Orthopaedics, 35, 1639-1645. http://dx.doi.org/10.1007/s00264-010-1205-3
[10] Roy, S.P., Tanki, U.F., Dutta, A., et al. (2012) Efficacy of Intra-Articular Tranexamic Acid in Blood Loss Reduction Following Primary Unilateral Total Knee Arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy, 20, 2494- 2501. http://dx.doi.org/10.1007/s00167-012-1942-5
[11] Sangasoongsong, P., Channoom, T., Kawinwonggowit, V., et al. (2011) Postoperative Blood Loss Reduction in Computer-Assisted Surgery Total Knee Replacement by Low Dose Intra-Articular Tranexamic Acid Injection Together with 2-Hour Clamp Drain: A Prospective Triple-Blinded Randomized Controlled Trial. Orthopedic Reviews, 3, e12.
[12] Seo, J.G., Moon, Y.W., Park, S.H., et al. (2013) The Comparative Efficacies of Intra-Articular and IV Tranexamic Acid for Reducing Blood Loss during Total Knee Arthroplasty. Knee Surgery Sports Traumatology Arthroscopy, 21, 1869-1874. http://dx.doi.org/10.1007/s00167-012-2079-2
[13] Wong, J., Abrishami, A., El Beheiry, H., et al. (2010) Topical Application of Tranexamic Acid Reduces Postoperative Blood Loss in Total Knee Arthroplasty: A Randomized, Controlled Trial. Journal of Bone & Joint Surgery American Volume, 92, 2503-2513. http://dx.doi.org/10.2106/JBJS.I.01518
[14] Kumar, G.S., Arx, O.V. and Pozo, J.L. (2005) Rate of Blood Loss over 48 Hours Following Total Knee Replacement. Knee, 12, 307-309. http://dx.doi.org/10.1016/j.knee.2004.08.008
[15] Jou, I.M., Lai, K.A., Yang, C.Y., et al. (1993) Blood Loss Associated with Total Knee Arthroplasty. Journal of Orthopedic Surgery Taiwan, 10.
[16] Aguileraroig, X., Jordánsales, M., Nateracisneros, L., et al. (2013) Tranexamic Acid in Orthopedic Surgery. Revista Espanola De Cirugia Ortopedica Y Traumatologia, 58, 52-56. http://dx.doi.org/10.1016/j.recot.2013.08.005
[17] 邱贵兴. 中国骨科大手术静脉血栓栓塞症预防指南[J]. 中华关节外科杂志: 电子版, 2009, 3(3):70-72.
[18] 陈玲敏, 张燕姿, 宋健楠, 等. 全膝关节置换术围手术期疼痛管理[J]. 华西医学, 2016(1): 180-183.
[19] Maheshwari, A.V., Blum, Y.C., Shekhar, L., et al. (2009) Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center. Clinical Orthopaedics & Related Research, 467, 1418-1423. http://dx.doi.org/10.1007/s11999-009-0728-7
[20] Mercuriali, F. and Inghilleri, G. (1996) Proposal of an Algorithm to Help the Choice of the Best Transfusion Strategy. Current Medical Research & Opinion, 13, 465-478. http://dx.doi.org/10.1185/03007999609115227
[21] Li, B., Wen, Y., Wu, H., et al. (2008) The Effect of Tourniquet Use on Hidden Blood Loss in Total Knee Arthroplasty. International Orthopaedics, 33, 1263-1268. http://dx.doi.org/10.1007/s00264-008-0647-3
[22] 高福强, 李子剑, 张克, 等. 人工关节置换术后隐性失血计算方法的初步探析[J]. 中华外科杂志, 2011, 49(12): 1144-1147.
[23] 王永才, 王红川, 蒋俊威, 等. 止血带的不同使用方法在膝关节置换术中的研究[J]. 中华关节外科杂志: 电子版, 2013, 7(3): 47-49.
[24] Sehat, K.R., Evans, R.L. and Newman, J.H. (2004) Hidden Blood Loss Following Hip and Knee Arthroplasty. Correct Management of Blood Loss Should Take Hidden Loss into Account. Journal of Bone and Joint Surgery (British Volume), 86. 561-565.
[25] Álvarez, J.C., Santiveri, F.X., Ramos, I., et al. (2008) Tranexamic Acid Reduces Blood Transfusion in Total Knee Arthroplasty Even When a Blood Conservation Program Is Applied. Transfusion, 48, 519-525. http://dx.doi.org/10.1111/j.1537-2995.2007.01564.x
[26] Alshryda, S., Mason, J., Sarda, P., et al. (2013) Topical (Intra-Articular) Tranexamic Acid Reduces Blood Loss and Transfusion Rates Following Total Hip Replacement: A Randomized Controlled Trial (TRANX-H). Journal of Bone & Joint Surgery American Volume, 95, 1961-1968. http://dx.doi.org/10.2106/JBJS.L.00907