摘要
[目的]比较骨蜡和氨甲环酸在单侧初次全膝关节置换术中减少出血量的效果。[方法]回顾性分析本院2013年1月一2014年12月符合纳入和排除标准的136例行单侧初次全膝关节置换术的患者资料。按照骨蜡和氨甲环酸的使用情况分为四组，分别为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：联合使用氨甲环酸和骨蜡。对术中失血量、术后24h引流量、术后血红蛋白变化、总失血量、输血比例、临床效果等指标进行评估，分析比较局部使用骨蜡和氨甲环酸减少单侧初次全膝关节置换术患者出血量的有效性和安全性。[结果]四组患者年龄、性别、BMI、Hb、PLT、PT、APTT、手术时间和术中止血带时间之间差异均无统计学意义（P〉0．05）；总失血量B组（728．84±240．15）ml、C组（570．55±235．12）ml和D组（531．99±167．55）ml，均明显低于A组（877．43±232．67）ml，差异具有统计学意义（P〈0．05），但B、C、D三组之间差异无统计学意义（P〈0．05）；输血率A组56．76％（21／37）、B组46．15％（18／39）之间差异无统计学意义（P〉0．05），但C组30．43％（7／23）和D组24．32％（9／37）输血率明显低于A组，差异有统计学意义（P〈0．05）；四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行单侧初次全膝关节置换术患者的失血量，但氨甲环酸止血效果优于骨蜡；联合使用骨蜡和氨甲环酸，止血效果优于单独使用骨蜡，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感染、切口愈合不良和血栓形成等风险，不影响术后功能康复。
[ Objective] To compare and analyze the effectiveness of bone wax and tranexamic acid in reducing the blood loss associated with unilateral primary TKA. [ Methods] A retrospective study was carried out to analyze the cases of 136 pa- tients who received unilateral primary TKA and satisfied inclusion and exclusion criteria during Jan 2013 to Dec 2014 in our Hos- pital. 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 effectiveness and safe- ty of bone wax and tranexamic acid in reducing blood loss in unilateral primary TKA was evaluated through assessing the intraop- erative blood loss, postoperative blood loss via drainage, postoperative hemoglobin drop, total blood loss, blood transfusion, clinical effects. [ Results] No difference of statistical significance （P 〉 0. 05 ） was found among the four groups in terms of age, gender, BMI, preoperative Hb, PLT, PT, AP＇Iq＇, time of operation and time of using tourniquet in operation. Significant difference （P 〈0. 05） was found in total blood loss, with group B reaching （728.84 _＋240. 15） ml, group C reaching （570. 55 ＋235. 12） ml, and group D reaching （531.99 _＋ 167.55） ml , significantly higher than group A reaching （877. 43 _＋232. 67） ml. But there was no significant difference among group B, C and D （ P 〉 0.05 ） ; As for blood transfusion rate, significant difference （P 〈 0. 05） was found, with group A reaching 56. 76% （21/37）, group B reaching 46. 15% （18/39）, group C reaching 30. 43% （7/23）, and group D reaching 24. 32% （9/37） . The blood transfusion rates of group A and B were similar （P 〉 0. 05 ）, so was the group C and D. But the rate of group C and D was lower than that of group A, and it had significant difference （P 〈 0. 05） . The four groups showed no difference of statistical significance in terms of other indicators including DVT, incision healing and infection rate. [ Conclusion] Using bone wax or tranexamic acid alone or a combination of both can significantly reduce perioperative blood loss in the unilateral pri- mary TKA, but compared with tranexamic acid, bone wax can not reduce the blood transfusion rate. The effectiveness of combination of both is better than bone wax while not better than that of tranexamic acid. Both bone wax and tranexamic acid will not increase the risk of complications such as infection rate, incision healing and DVT.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2016年第3期193-197,共5页
Orthopedic Journal of China
关键词
骨蜡
氨甲环酸
关节成形术
置换
膝
止血
bone wax, tranexamic acid, arthroplasty, replacement, knee, hemostasis
作者简介
万伏银，在读硕士研究生，研究方向：关节外科，（电话）13051701844，（电子信箱）jshzwfy@126．com
通讯作者：（电子信箱）guowanshou@263．net
