氨甲环酸在髋关节翻修术中应用的研究进展
Research Progress on the Application of Tranexamic Acid in Revision Hip Arthroplasty
摘要: 由于全球预期寿命的增加，关节置换术的总数也有所增加。全髋关节置换术(THA)通常用于髋关节骨关节炎患者，而全髋关节置换术(THA)期间失血量达到1000至1500毫升之间，输血率在21%到70%之间。尽管输血可以挽救生命，但输血与已知的有时会危及生命的不良事件有关。氨甲环酸(TXA)是一种抗纤溶的药物，广泛应用于接受THA的患者。而TXA在THA中的有效性及安全性已被证实，这为骨科医生降低失血量，输血率以及术后并发症更多的髋关节翻修术(RHA)的围手术期失血量及输血率而指了一条明路。本文对以氨甲环酸在全髋关节置换翻修术中的应用进行了综述。首先介绍了TXA的作用机制，包括其抑制纤维蛋白溶解作用和减少纤维蛋白溶酶原激活的能力。随后，回顾了已发布的研究，探讨了TXA在全髋关节置换翻修术中的疗效和安全性。研究结果显示，TXA能够显著减少手术过程中的出血量和输血需求，同时并不增加手术并发症的风险。一些研究还发现，更早地应用TXA可以获得更好的止血效果。综上所述，以氨甲环酸在全髋关节置换翻修术中的应用显示出良好的止血效果和安全性。然而，我们仍然需要进一步的研究，以进一步明确其最佳应用时间和剂量，为临床实践提供更可靠的依据。
Abstract: As global life expectancy rises, so does the number of joint replacement surgeries. Total Hip Arthro-plasty (THA) is commonly performed on patients with hip osteoarthritis, with blood loss during surgery ranging from 1000 to 1500 milliliters and transfusion rates between 21% and 70%. Alt-hough blood transfusions can be lifesaving, they are associated with potentially life-threatening adverse events. Tranexamic Acid (TXA), an antifibrinolytic medication, has been widely used in pa-tients undergoing THA. Its effectiveness and safety in THA have been confirmed, offering orthopedic surgeons a clearer path to reduce blood loss, transfusion rates, and postoperative complications in Revision Hip Arthroplasty (RHA). This article reviews the application of TXA in revision hip arthro-plasty. It first introduces the mechanism of action of TXA, including its ability to inhibit fibrinolysis and reduce the activation of plasminogen to plasmin. Subsequently, it reviews published studies to discuss the efficacy and safety of TXA in hip revision surgeries. The findings indicate that TXA sig-nificantly reduces intraoperative blood loss and the need for blood transfusions without increasing the risk of surgical complications. Some studies have also found that earlier application of TXA can achieve better hemostatic effects. In summary, the application of tranexamic acid in RHA has shown good hemostatic effect and safety. However, further research is still needed to further clarify the op-timal timing and dosage for clinical practice.
文章引用：伊力夏提·麦麦提艾麦尔, 阿斯哈尔江·买买提依明. 氨甲环酸在髋关节翻修术中应用的研究进展[J]. 临床医学进展, 2024, 14(3): 1192-1198. https://doi.org/10.12677/ACM.2024.143828

参考文献

[1] Lehil, M.S. and Bozic, K.J. (2014) Trends in Total Hip Arthroplasty Implant Utilization in the United States. The Journal of Arthroplasty, 29, 1915-1918. [Google Scholar] [CrossRef] [PubMed]
[2] Nguyen, L.C., Lehil, M.S. and Bozic, K.J. (2015) Trends in Total Knee Arthroplasty Implant Utilization. The Journal of Arthroplasty, 30, 739-742. [Google Scholar] [CrossRef] [PubMed]
[3] Peersman, G., Laskin, R., Davis, J. and Peterson, M. (2001) Infec-tion in Total Knee Replacement: A Retrospective Review of 6489 Total Knee Replacements. Clinical Orthopaedics and Related Research, 392, 15-23. [Google Scholar] [CrossRef] 
[4] Patel, V.P., Walsh, M., Sehgal, B., Preston, C., DeWal, H. and Di Cesare, P.E. (2007) Factors Associated with Prolonged Wound Drainage after Primary Total Hip and Knee Arthroplasty. The Journal of Bone & Joint Surgery, 89, 33-38. [Google Scholar] [CrossRef] 
[5] Soohoo, N.F., Zingmond, D.S., Lieberman, J.R. and Ko, C.Y. (2006) Optimal Timeframe for Reporting Short-Term Complication Rates after Total Knee Arthroplasty. The Jour-nal of Arthroplasty, 21, 705-711. [Google Scholar] [CrossRef] [PubMed]
[6] Kurtz, S., Ong, K., Lau, E., Mowat, F. and Halpern, M. (2007) Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030. The Journal of Bone & Joint Surgery, 89, 780-785. [Google Scholar] [CrossRef] 
[7] Oremus, K. (2015) Tranexamic Acid for the Reduction of Blood Loss in Total Knee Arthroplasty. Annals of Translational Medicine, 3, S40.
[8] Ponnusamy, K.E., Kim, T.J. and Khanuja, H.S. (2014) Perioperative Blood Transfusions in Orthopaedic Surgery. The Journal of Bone and Joint Surgery, 96, 1836-1844.
[9] Ho, K.M. and Ismail, H. (2003) Use of Intravenous Tranexamic Acid to Reduce Alloge-neic Blood Transfusion in Total Hip and Knee Arthroplasty: A Meta-Analysis. Anaesthesia and Intensive Care, 31, 529-537. [Google Scholar] [CrossRef] 
[10] Bridgens, J.P., Evans, C.R., Dobson, P.M. and Hamer, A.J. (2007) Intraoperative Red Blood-Cell Salvage in Revision Hip Surgery. A Case-Matched Study. The Journal of Bone & Joint Surgery, 89, 270-275. [Google Scholar] [CrossRef] 
[11] Cardone, D. and Klein, A.A. (2009) Perioperative Blood Conservation. European Journal of Anaesthesiology, 26, 722-729. [Google Scholar] [CrossRef] 
[12] Zufferey, P., Merquiol, F., Laporte, S., Decousus, H., Mismetti, P., Auboyer, C., Samama, C.M. and Molliex, S. (2006) Do Anti-fibrinolytics Reduce Allogeneic Blood Transfusion in Orthopedic Surgery? Anesthesiology, 105, 1034-1046. [Google Scholar] [CrossRef] [PubMed]
[13] Bierbaum, B.E., Callaghan, J.J., Galante, J.O., Rubash, H.E., Tooms, R.E. and Welch, R.B. (1999) An Analysis of Blood Management in Patients Having a Total Hip or Knee Arthroplasty. The Journal of Bone & Joint Surgery, 81, 2-10. [Google Scholar] [CrossRef] [PubMed]
[14] Carling, M.S., Jeppsson, A., Eriksson, B.I. and Brisby, H. (2015) Transfusions and Blood Loss in Total Hip and Knee Arthroplasty: A Prospective Observational Study. Jour-nal of Orthopaedic Surgery and Research, 10, Article No. 48. [Google Scholar] [CrossRef] [PubMed]
[15] Struijk-Mulder, M.C., Horstmann, W.G., Verheyen, C.C. and Ettema, H.B. (2014) Ten-Year Follow-Up on Dutch Orthopaedic Blood Management (DATA III Survey). Archives of Orthopaedic and Trauma Surgery, 134, 15-20. [Google Scholar] [CrossRef] [PubMed]
[16] Alshryda, S., Sukeik, M., Sarda, P., Blenkinsopp, J., Haddad, F.S. and Mason, J.M. (2014) A Systematic Review and Meta-Analysis of the Topical Administration of Tranexamic Acid in Total Hip and Knee Replacement. The Bone & Joint Journal, 96-B, 1005-1015. [Google Scholar] [CrossRef] 
[17] Zhang, H., Chen, J., Chen, F. and Que, W. (2012) The Effect of Tranexamic Acid on Blood Loss and Use of Blood Products in Total Knee Arthroplasty: A Meta-Analysis. Knee Sur-gery, Sports Traumatology, Arthroscopy, 20, 1742-1752. [Google Scholar] [CrossRef] [PubMed]
[18] Yang, Z.G., Chen, W.P. and Wu, L.D. (2012) Effectiveness and Safety of Tranexamic Acid in Reducing Blood Loss in Total Knee Arthroplasty: A Meta-Analysis. The Journal of Bone & Joint Surgery, 94, 1153-1159. [Google Scholar] [CrossRef] 
[19] Phillips, S.J., Chavan, R., Porter, M.L., Kay, P.R., Hodgkinson, J.P., Purbach, B., Reddick, A.H. and Frayne, J.M. (2006) Does Salvage and Tranexamic Acid Reduce the Need for Blood Transfusion in Revision Hip Surgery? The Bone & Joint Journal, 88, 1141-1142. [Google Scholar] [CrossRef] 
[20] Carless, P.A., Henry, D.A., Carson, J.L., et al. (2010) Transfusion Thresholds and Other Strategies for Guiding Allogeneic Red Blood Cell Transfusion. Cochrane Database of Systematic Reviews, 10, CD002042. [Google Scholar] [CrossRef] 
[21] Wilson, K. and Hébert, P.C. (2003) The Challenge of an Increasingly Expensive Blood System. Canadian Medical Association Journal, 168, 1149-1150.
[22] Sullivan, M.T., Cotten, R., Read, E.J., et al. (2007) Blood Collection and Transfusion in the United States in 2001. Transfusion, 47, 385-394. [Google Scholar] [CrossRef] [PubMed]
[23] Glance, L.G., Dick, A.W., Mukamel, D.B., Fleming, F.J., Zollo, R.A., Wissler, R., Salloum, R., Meredith, U.W. and Osler, T.M. (2011) Association between In-traoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery. Anesthesiology, 114, 283-292. [Google Scholar] [CrossRef] 
[24] Surgenor, S.D., Kramer, R.S., Olmstead, E.M., Ross, C.S., Sellke, F.W., Likosky, D.S., Marrin, C.A., Helm Jr., R.E., Leavitt, B.J., Morton, J.R., Charlesworth, D.C., Clough, R.A., Hernandez, F., Frumiento, C., Benak, A., DioData, C. and O’Connor, G.T. (2009) The Association of Perioperative Erythrochites Transfusions and Decreased Longterm Survival after Cardiac Surgery. Anesthesia & An-algesia, 108, 1741-1746. [Google Scholar] [CrossRef] [PubMed]
[25] Astedt, B. (1987) Clinical Pharmacology of Tranexamic Acid. Scandinavian Journal of Gastroenterology Supplement, 137, 22-25.
[26] Alshryda, S., Mason, J., Vaghela, M., Sarda, P., Nargol, A., Maheswaran, S., Tulloch, C., Anand, S., Logishetty, R., Stothart, B. and Hungin, A.P. (2013) Topical (Intra-Articular) Tranexamic Acid Reduces Blood Loss and Transfusion Rates Following Total Knee Replacement: A Randomized Controlled Trial (TRANX-K). The Journal of Bone & Joint Surgery, 95, 1961-1968. [Google Scholar] [CrossRef] 
[27] Engel, J.M., Hohaus, T., Ruwoldt, R., Menges, T., Jürgensen, I. and Hempelmann, G. (2001) Regional Hemostatic Status and Blood Requirements after Total Knee Arthroplasty with and without Tranexamic Acid or Aprotinin. Anesthesia & Analgesia, 92, 775-780. [Google Scholar] [CrossRef] 
[28] Xie, J., Hu, Q., Ma, J., Huang, Q. and Pei, F. (2017) Multiple Boluses of Intravenous Tranexamic Acid to Reduce Hidden Blood Loss and the Inflammatory Response Fol-lowing Enhanced-Recovery Primary Total Hip Arthroplasty: A Randomised Clinical Trial. The Bone & Joint Journal, 99-B, 1442-1449. [Google Scholar] [CrossRef] 
[29] Fillingham, Y.A., Ramkumar, D.B., Jevsevar, D.S., Yates, A.J., Bini, S.A., Clarke, H.D., Schemitsch, E., Johnson, R.L., Memtsoudis, S.G., Sayeed, S.A., Sah, A.P. and Della Valle, C.J. (2019) Tranexamic Acid in Total Joint Arthroplasty: The Endorsed Clinical Practice Guides of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, Ameri-can Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. Regional Anesthesia & Pain Medicine, 44, 7-11. [Google Scholar] [CrossRef] [PubMed]
[30] Fillingham, Y.A., Ramkumar, D.B., Jevsevar, D.S., Yates, A.J., Shores, P., Mullen, K., Bini, S.A., Clarke, H.D., Schemitsch, E., Johnson, R.L., Memtsoudis, S.G., Sayeed, S.A., Sah, A.P. and Della Valle, C.J. (2018) The Efficacy of Tranexamic Acid in Total Hip Arthroplasty: A Network Meta-Analysis. The Journal of Arthroplasty, 33, 3083-3089.E4. [Google Scholar] [CrossRef] [PubMed]
[31] Pavenski, K., Ward, S.E., Hare, G.M.T., Freedman, J., Pulendrara-jah, R., Pirani, R.A., Sheppard, N., Vance, C., White, A., Lo, N., Waddell, J.P., Ho, A., Schemitsch, E.H., Kataoka, M., Bogoch, E.R., Saini, K., David Mazer, C. and Baker, J.E. (2019) A Rationale for Universal Tranexamic Acid in Major Joint Arthroplasty: Overall Efficacy and Impact of Risk Factors for Transfusion. Transfusion, 59, 207-216. [Google Scholar] [CrossRef] [PubMed]
[32] Sehat, K.R., Evans, R.L. and Newman, J.H. (2004) Hidden Blood Loss Fol-lowing Hip and Knee Arthroplasty. Correct Management of Blood Loss Should Take Hidden Loss into Account. The Bone & Joint Journal, 86, 561-565. [Google Scholar] [CrossRef] 
[33] Yamasaki, S., Masuhara, K. and Fuji, T. (2004) Tranexamic Acid Reduces Blood Loss after Cementless Total Hip Arthroplasty-Prospective Randomized Study in 40 Cases. Interna-tional Orthopaedics, 28, 69-73. [Google Scholar] [CrossRef] [PubMed]
[34] Moskal, J.T. and Capps, S.G. (2016) Meta-Analysis of Intrave-nous Tranexamic Acid in Primary Total Hip Arthroplasty. Orthopedics, 39, e883-e892. [Google Scholar] [CrossRef] [PubMed]
[35] Fillingham, Y.A., Ramkumar, D.B., Jevsevar, D.S., Yates, A.J., Shores, P., Mullen, K., Bini, S.A., Clarke, H.D., Schemitsch, E., Johnson, R.L., Memtsoudis, S.G., Sayeed, S.A., Sah, A.P. and Della Valle, C.J. (2018) The Safety of Tranexamic Acid in Total Joint Arthroplasty: A Direct Me-ta-Analysis. The Journal of Arthroplasty, 33, 3070-3082.E1. [Google Scholar] [CrossRef] [PubMed]
[36] Zak, S.G., Tang, A., Sharan, M., Waren, D., Rozell, J.C. and Schwarzkopf, R. (2021) Tranexamic Acid Is Safe in Patients with a History of Coronary Artery Disease Undergoing Total Joint Arthroplasty. The Journal of Bone and Joint Surgery, 103, 900-904. [Google Scholar] [CrossRef] 
[37] Kirksey, M.A., Wilson, L.A., Fiasconaro, M., Poeran, J., Liu, J. and Memtsoudis, S.G. (2020) Tranexamic Acid Administration during Total Joint Arthroplasty Surgery Is Not Associated with an Increased Risk of Perioperative Seizures: A National Database Analysis. Regional Anesthesia & Pain Medicine, 45, 505-508. [Google Scholar] [CrossRef] [PubMed]
[38] Houston, B.L., Fergusson, D.A., Falk, J., Krupka, E., Perelman, I., Breau, R.H., McIsaac, D.I., Rimmer, E., Houston, D.S., Garland, A., Ariano, R.E., Tinmouth, A., Balshaw, R., Turgeon, A.F., Jacobsohn, E. and Zarychanski, R. (2021) Prophylactic Tranexamic Acid Use in Non-Cardiac Surgeries at High Risk for Transfusion. Transfusion Medicine, 31, 236-242. [Google Scholar] [CrossRef] [PubMed]
[39] Wong, J., Abrishami, A., El Beheiry, H., Mahomed, N.N., Roderick Davey, J., Gandhi, R., Syed, K.A., Muhammad Ovais Hasan, S., De Silva, Y. and Chung, F. (2010) Topical Application of Tranexamic Acid Reduces Postoperative Blood Loss in Total Knee Arthroplasty: A Randomized, Controlled Trial. The Journal of Bone & Joint Surgery, 92, 2503-2513. [Google Scholar] [CrossRef] 
[40] Jules-Elysee, K.M., Tseng, A., Sculco, T.P., Baaklini, L.R., McLawhorn, A.S., Pickard, A.J., Qin, W., Cross, J.R., Su, E.P., Fields, K.G. and Mayman, D.J. (2019) Comparison of Topical and Intravenous Tranexamic Acid for Total Knee Replacement: A Randomized Double-Blinded Controlled Study of Effects on Tranexamic Acid Levels and Thrombogenic and Inflammatory Marker Levels. The Journal of Bone and Joint Surgery, 101, 2120-2128. [Google Scholar] [CrossRef] 
[41] Ye, W., Liu, Y., Liu, W.F., Li, X.L., Fei, Y. and Gao, X. (2020) Comparison of Efficacy and Safety between Oral and Intravenous Administration of Tranexamic Acid for Primary Total Knee/Hip Replacement: A Meta-Analysis of Randomized Controlled Trial. Journal of Orthopaedic Surgery and Re-search, 15, Article No. 21. [Google Scholar] [CrossRef] [PubMed]
[42] Xu, S., Chen, J.Y., Zheng, Q., Lo, N.N., Chia, S.L., Tay, K.J.D., Pang, H.N., Shi, L., Chan, E.S.Y. and Yeo, S.J. (2019) The Safest and Most Efficacious Route of Tranexamic Acid Ad-ministration in Total Joint Arthroplasty: A Systematic Review and Network Meta-Analysis. Thrombosis Research, 176, 61-66. [Google Scholar] [CrossRef] [PubMed]
[43] Clave, A., Fazilleau, F., Dumser, D., et al. (2012) Efficacy of Tranexamic Acid on Blood Loss after Primary Cementless Total Hip Re-Placement with Rivaroxaban Thromboprophy-laxis: A Case-Control Study in 70 Patients. Orthopaedics & Traumatology: Surgery & Research, 98, 484-490. [Google Scholar] [CrossRef] [PubMed]
[44] 傅峥, 张健, 姚海. 氨甲环酸对全髋关节置换术隐性失血的影响[J]. 重庆医科大学学报, 2012, 37(4): 359-361.
[45] Alshryda, S., Mason, J., Sarda, P., Nargol, A., Cooke, N., Ahmad, H., Tang, S., Logishetty, R., Vaghela, M., McPartlin, L. and Hungin, A.P. (2013) Topical (Intra-Articular) Tranexamic Acid Reduces Blood Loss and Transfusion Rates Following Total Hip Replacement: A Randomized Con-trolled Trial (TRANX-H). The Journal of Bone & Joint Surgery, 95, 1969-1974. [Google Scholar] [CrossRef] 
[46] Wang, C., Xu, G.J., Han, Z., Ma, J.X., Ma, X.L., Jiang, X. and Wang, Y. (2015) Topical Application of Tranexamic Acid in Primary Total Hip Arthroplasty: A Systemic Review and Me-ta-Analysis. International Journal of Surgery, 15, 134-139. [Google Scholar] [CrossRef] [PubMed]
[47] 岳辰, 谢锦伟, 蔡东峰, 等. 静脉联合局部应用氨甲环酸减少初次全髋关节置换术围手术期失血的有效性及安全性研究[J]. 中华骨与关节外科杂志, 2015(1): 44-48.
[48] Klement, M.R., Padua, F.G., Li, W.T., Detweiler, M. and Parvizi, J. (2020) Tranexamic Acid Reduces the Rate of Periprosthetic Joint Infection after Aseptic Revision Arthroplasty. The Journal of Bone and Joint Surgery, 102, 1344-1350. [Google Scholar] [CrossRef] 
[49] Yazdi, H., Klement, M.R., Hammad, M., Inoue, D., Xu, C., Goswami, K. and Parvizi, J. (2020) Tranexamic Acid Is Associated with Reduced Periprosthetic Joint Infection after Primary Total Joint Arthroplasty. The Journal of Arthroplasty, 35, 840-844. [Google Scholar] [CrossRef] [PubMed]

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