中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (18): 2852-2858.doi: 10.12307/2024.044

• 人工假体 artificial prosthesis • 上一篇    下一篇

初次全膝置换中氨甲环酸一种改良局部应用的效果分析

李博伟1，2，潘文杰2，徐  超2，黄袁迟2，马建兵2   

  1. 1西安医学院，陕西省西安市   710068；2西安交通大学附属红会医院膝关节病区，陕西省西安市   710054
  • 收稿日期:2023-03-17 接受日期:2023-04-22 出版日期:2024-06-28 发布日期:2023-08-24
  • 通讯作者: 马建兵，博士，主任医师，博士生导师，西安交通大学附属红会医院膝关节病区，陕西省西安市 710054 黄袁迟，博士，主治医师，西安交通大学附属红会医院膝关节病区，陕西省西安市 710054
  • 作者简介:李博伟，男，1998年生，陕西省西安市人，汉族，西安医学院骨科在读硕士，主要从事关节置换和骨关节炎方面的研究。
  • 基金资助:
    陕西省自然科学基础研究计划项目(2017JM8167)，项目负责人：潘文杰

Effect analysis of a modified topical application of tranexamic acid in primary total knee arthroplasty

Li Bowei1, 2, Pan Wenjie2, Xu Chao2, Huang Yuanchi2, Ma Jianbing2   

  1. 1Xi’an Medical University, Xi’an 710068, Shaanxi Province, China; 2Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • Received:2023-03-17 Accepted:2023-04-22 Online:2024-06-28 Published:2023-08-24
  • Contact: Ma Jianbing, MD, Chief physician, Doctoral supervisor, Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China Huang Yuanchi, MD, Attending physician, Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • About author:Li Bowei, Master candidate, Xi’an Medical University, Xi’an 710068, Shaanxi Province, China; Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • Supported by:
    Shaanxi Provincial Natural Science Basic Research Plan Project, No. 2017JM8167 (to PWJ)

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摘要：


文题释义：

氨甲环酸：是一种人工合成的赖氨酸衍生物，与纤维蛋白高亲和的赖氨酸结合位点强烈吸附，通过阻止纤溶酶原、纤溶酶与纤维蛋白相互结合，从而抑制纤维蛋白分解，具有止血和预防出血的作用，目前被广泛应用于整形科、胸外科、骨科、耳鼻喉科、妇科等很多领域。
全膝关节置换伴发大量失血：由于膝关节具有丰富而复杂的血运，导致全膝关节置换术中滑膜、软组织剥离以及测量截骨等常规操作皆会引发大量的术中出血和术后隐性出血。此外，为了方便术中操作，应用止血带所引起的纤溶反应也会加剧出血。大量的围术期出血会延缓患者的恢复速度、削弱功能锻炼的效果、增加术后输血风险等，对患者造成种种负面影响。因此，采取合适的止血措施和围术期血液管理是至关重要的，能够显著改善患者术后的生活质量。


背景：近些年来，氨甲环酸被广泛应用来应对全膝关节置换术中产生的大量失血，但局部应用的最佳方法还没有定论。

目的：评估术中局部应用氨甲环酸联合物理加压包扎降低全膝关节置换围术期出血量的有效性和安全性。
方法：回顾性分析2021年1月至2022年12月在西安市红会医院进行全膝关节置换的90例患者，根据术中氨甲环酸不同局部使用方法将患者分为3组，每组30例。加压包扎组将2 g氨甲环酸置于关节腔内，纱布和棉垫填塞伤口后使用绷带对伤口加压包扎；周围浸润组将2 g氨甲环酸注射到关节腔周围组织；腔内注射组将2 g氨甲环酸注射于关节腔内。统计分析3组患者的出血量、手术时间、凝血指标、炎症指标以及术后并发症。

结果与结论：①在总失血量、隐性失血量、血红蛋白下降值方面，周围浸润组最少，加压包扎组和周围浸润组无统计学差异(P > 0.05)；在术中失血量方面，加压包扎组最少，且与周围浸润组、腔内注射组比较，均有统计学差异(P < 0.05)；在手术时长方面，3组患者比较均无统计学差异(P > 0.05)；②3组患者术前，术后第1，3天凝血指标(D-二聚体、纤维蛋白降解产物)和炎症指标(C-反应蛋白、红细胞沉降率)均无统计学差异(P > 0.05)；③3组患者在患肢血流缓慢、肌间静脉血栓、软组织肿胀、伤口并发症发生率方面均无统计学差异(P > 0.05)，且均未出现深静脉血栓和肺栓塞；④局部应用氨甲环酸联合加压包扎这一方式，在操作简单、减少围术期失血量方面达到与关节腔周围注射效果相同的同时，避免了反复穿刺带来的创伤，也未增加术后并发症的发生率，值得临床推广。

https://orcid.org/0009-0002-6312-1099 (李博伟) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 全膝关节置换, 氨甲环酸, 加压包扎, 部注射, 关节内注射, 失血量, 炎症反应, 静脉血栓

Abstract: BACKGROUND: In recent years, tranexamic acid has been extensively used to mitigate the substantial blood loss associated with total knee arthroplasty. However, the optimal method of topical application has not yet been established.
OBJECTIVE: To evaluate the effectiveness and safety of intraoperative topical application of tranexamic acid combined with physical compression dressing in reducing perioperative blood loss in total knee arthroplasty.
METHODS: A retrospective analysis was conducted on 90 patients who underwent total knee arthroplasty at the Honghui Hospital in Xi’an from January 2021 to December 2022. Based on the different topical use methods of tranexamic acid during surgery, patients were divided into three groups, with 30 cases in each group. In the compression dressing group, 2 g of tranexamic acid was placed in the articular cavity, and after packing the wound with gauze and cotton pads, a bandage was used to compress the wound. In the periarticular injection group, 2 g of tranexamic acid was injected into the surrounding tissue of the articular cavity. In the intra-articular injection group, 2 g of tranexamic acid was injected into the articular cavity. The blood loss, operation time, coagulation indicators, inflammatory indicators, and postoperative complications of the three groups were statistically analyzed. 
RESULTS AND CONCLUSION: (1) In terms of total blood loss, hidden blood loss, and maximum hemoglobin drop, the periarticular injection group had the least amount, and there was no statistically significant difference between the compression dressing group and periarticular injection group (P > 0.05). In terms of intraoperative blood loss, the compression dressing group had the least amount, and there were statistically significant differences compared with the periarticular injection group and intra-articular injection group (P < 0.05). There was no statistically significant difference in operation time among the three groups (P > 0.05). (2) There were no statistically significant differences in coagulation indicators (D-dimer and fibrinogen degradation products) and inflammation indicators (C-reactive protein and erythrocyte sedimentation rate) among the three groups preoperatively and on the first and third days after operation (P > 0.05). (3) There was no statistically significant difference observed among the three groups in terms of slow blood flow in the affected limb, intramuscular venous thrombosis, soft tissue swelling, and incidence of wound complications (P > 0.05). Additionally, no cases of deep vein thrombosis or pulmonary embolism were detected in any of the groups. (4) The topical application of tranexamic acid combined with compression dressing achieves the same effect as a periarticular injection in terms of simplicity of operation and reduced perioperative blood loss. This method also avoids the trauma caused by repeated punctures and does not increase the incidence of postoperative complications, making it a worthwhile option for clinical promotion.

Key words: total knee arthroplasty, tranexamic acid, compression dressing, topical injection, intra-articular injection, blood loss, inflammatory response, venous thrombosis

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