中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (44): 6564-6569.doi: 10.3969/j.issn.2095-4344.2016.44.004

• 人工假体 artificial prosthesis • 上一篇    下一篇

关节腔内加压灌注氨甲环酸与初次全膝关节置换后失血量的关系

陈群群1，陈建发2，周 驰2，董路珏2，霍少川1，王海彬2   

  1. 1广州中医药大学附属骨伤科医院，广东省广州市 510240；2广州中医药大学第一附属医院，广东省广州市 510405
  • 修回日期:2016-08-08 出版日期:2016-10-28 发布日期:2016-10-28
  • 通讯作者: 王海彬，教授，博士生导师，主任医师，广州中医药大学第一附属医院，广东省广州市 510405
  • 作者简介:陈群群，男，1984年生，汉族，广州中医药大学第一临床医学院2014级在读博士研究生，主治医师，主要从事关节外科方面的研究。

Blood loss in primary total knee replacement with intra-articular injection of tranexamic acid and presurization

Chen Qun-qun1, Chen Jian-fa2, Zhou Chi2, Dong Lu-jue2, Huo Shao-chuan1, Wang Hai-bin2   

  1. 1Traumatic and Orthopedic Hospital Affiliated to Guangzhou University of Chinese Medicine, Guangzhou 510240, Guangdong Province, China; 2the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Revised:2016-08-08 Online:2016-10-28 Published:2016-10-28
  • Contact: Wang Hai-bin, Professor, Doctoral supervisor, Chief physician, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • About author:Chen Qun-qun, Studying for doctorate, Attending physician, Traumatic and Orthopedic Hospital Affiliated to Guangzhou University of Chinese Medicine, Guangzhou 510240, Guangdong Province, China

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文题释义：
氨甲环酸：氨甲环酸是一种抗纤溶药物，可以竞争性阻抑纤溶酶原在纤维蛋白上的吸附，防止其激活，保护纤维蛋白不被纤溶酶所降解和溶解，从而达到止血的效果。氨甲环酸这种良好的止血特点应用在全膝关节手术也可以减少术后出血。
加压灌注：关节腔内加压灌注氨甲环酸及关节腔外加压包扎可以使关节腔内保持一定的压力，这种压力可有效维持并增加局部关节腔内药物浓度，使高浓度的氨甲环酸溶液与关节周围软组织有充足的时间反应结合，充分发挥抗纤溶作用，最大限度的减少出血，达到最佳的止血效果。
 
摘要
背景：氨甲环酸在全膝关节置换过程中的使用逐渐盛行，使用方法不一。
目的：探讨关节腔内加压灌注氨甲环酸对初次全膝关节置换后失血量的影响及安全性。
方法：选择拟行单侧全膝关节置换的患者56例，随机分为2组。试验组置换后关节腔内注射100 mL溶有2.0 g氨甲环酸的生理盐水，大棉垫加压包扎膝关节，夹闭引流管4 h后负压吸引；对照组置换后常规大棉垫包扎，夹闭引流管4 h后负压吸引。置换后48 h内拔除引流管；置换后3 d每天复查患者血常规，并记录引流量；置换后四至五天行患侧下肢静脉彩超检查，观察血栓发生率。
结果与结论：①试验组的手术总失血量、置换后显性失血量、置换后隐性失血量明显少于对照组(P < 0.05)；②2组患者在置换后血栓发生率方面差异无显著性意义(P > 0.05)；③结果提示，关节腔内加压灌注氨甲环酸能显著减少初次膝关节置换后的失血量，同时不增加下肢静脉血栓的风险。

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

ORCID: 0000-0002-1046-2650(陈群群)

关键词: 骨科植入物, 人工假体, 氨甲环酸, 膝关节置换, 失血量, 加压灌注

Abstract:

BACKGROUND: Tranexamic acid is extensively used in the primary total knee replacement, but there are many different methods.

OBJECTIVE: To explore the efficacy and safety of the intra-articular injection of tranexamic acid with pressurization in reducing the blood loss of primary total knee replacement.
METHODS: Totally 56 patients undergoing unilateral total knee arthroplasty were enrolled and randomly divided into two groups. Patients were given the intra-articular injection of 100 mL of saline solution dissolving 2.0 g of tranexamic acid with large pad pressure bandaging the knee, and 4-hour drainage tube close, and then underwent negative pressure suction (experimental group); differently, the controls were given the normal pad bandage group. The drainage tube was removed within 48 hours after replacement. The patient blood routine examination was performed at the 3rd day, and at the same time, the volume of drainage was recorded; and the color Doppler ultrasound in ipsilateral lower extremity veins was conducted to observe the incidence of thrombosis at 4-5 days.
RESULTS AND CONCLUSION: (1) The total blood loss, postoperative dominant blood loss, and hidden blood loss in the experimental group were significantly less than those in the control group (P < 0.05). (2) No significant difference was found in the incidence of postoperative thrombosis between two groups (P > 0.05). (3) These results indicate that the intra-articular injection of tranexamic acid with pressurization can significantly reduce the postoperative blood loss in the primary total knee arthroplasty, without increasing the risk of deep vein thrombosis.

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

Key words: Arthroplasty, Replacement, Knee, Tranexamic Acid, Blood Loss, Surgical, Tissue Engineering

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