局部应用氨甲环酸减少肿瘤型人工膝关节置换术后失血的有效性及安全性研究
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摘要
目的:探讨氨甲环酸局部关节腔内注射对减少肿瘤型人工膝关节置换术后失血的有效性及安全性。方法:回顾性分析从2016年1月至2017年10月因恶性肿瘤需要行肿瘤型人工膝关节置换并符合纳入标准的72例患者的病例资料,男47例,女25例,年龄11～49岁,平均年龄(26.8±11.9)岁,其中实验组为42例局部应用氨甲环酸1 g,并以30例未使用氨甲环酸为对照组,术前查血常规、凝血等指标及术后3天每天查血常规,并记录引流量,术后7天复查双下肢深静脉彩超。结果:实验组术后引流量[股骨远端组为(263.5±86.5)ml,胫骨近端组为(288.1±71.5)ml]以及隐性失血量[股骨远端组为(867.9±294.2)ml,胫骨近端为(943.8±274.4)ml]明显少于对照组[股骨远端引流量为(333.6±94.8)ml,胫骨近端为(375.3±111.5)ml;股骨远端组隐性出血量为(1 182.7±256.2)ml;胫骨近端组为(1 174.0±292.1)ml],差异均有统计学意义(P<0.05)。实验组(股骨远端组输血率34.6%,胫骨近端组为37.5%)输血人数明显小于对照组(股骨远端组输血率66.7%,胫骨近端组为73.3%),差异均有统计学意义(P<0.05)。两组患者在术后均未有血栓形成,术后患肢周径变化方面差异无统计学意义(P> 0. 05)。结论:肿瘤型人工膝关节置换术后局部应用氨甲环酸明显减少术后出血量,降低输血率,降低患者围手术期的贫血相关并发症的风险,且操作简单、安全、经济。
Objective:To investigate the perioperative efficacy and safety of local application of tranexmic acid for bleeding after unilateral tumor-type knee arthroplasty.Methods:From January 2016 to October 2017,clinical data of 72 patients who received tumor knee arthroplasty were analyzed retrospectively,including 47 male and 25 female patients,age from 11 to 49 years(26.8±11.9).The patients in experimental group received 1 g tranexamic acid inside knee joint,and patients in control group did not receive tranexamic acid.The blood routine examination,coagulation and other indications were detected before operation and the blood routine was checked after operation every day for 3 days.The amounts of intraoperative blood loss,postoperative visible blood loss,blood transfusion record and preoperative and postoperative limb circumference changes were recorded.The double-leg deep venous ultrasound was used seven days after operation.Results:The postoperative drainage[Distal femur group(263.5±86.5)ml,the proximal tibia group(288.1±71.5)ml]and the amount of invisible blood loss[Distal femur group(867.9±294.2)ml,the proximal tibea group(943.8±274.4)ml] in the experimental group were significantly less than those in the control group[drainage for the distal femur group(333.6±94.8)ml and the proximal tibia group(375.3±111.5)ml,while the invisible blood loss from distal femur group(1 182.7±256.2)ml and the proximal tibia group(1 174.0±292.1)ml],with significant difference(P<0.05).The number of blood transfusion in experimental group(Distal femur group 34.6%,the proximal tibia group 37.5%)was significantly less than that in control group(Distal femur group 66.7%,the proximal tibia group 73.3%),and the difference was statistically significant(P<0.05).There was no significant difference in postoperative thrombus incidence and postoperative limb circumference between the two groups(P>0.05).Conclusion:The local application of tranexamic acid intraoperatively in unilateral tumor knee arthroplasty patients could significantly reduce the amounts of postoperative blood loss and blood transfusion to avoid the perioperative anemia related complications.It is also safe,ecnomic and easy to use during surgery.
Objective:To investigate the perioperative efficacy and safety of local application of tranexmic acid for bleeding after unilateral tumor-type knee arthroplasty.Methods:From January 2016 to October 2017,clinical data of 72 patients who received tumor knee arthroplasty were analyzed retrospectively,including 47 male and 25 female patients,age from 11 to 49 years(26.8±11.9).The patients in experimental group received 1 g tranexamic acid inside knee joint,and patients in control group did not receive tranexamic acid.The blood routine examination,coagulation and other indications were detected before operation and the blood routine was checked after operation every day for 3 days.The amounts of intraoperative blood loss,postoperative visible blood loss,blood transfusion record and preoperative and postoperative limb circumference changes were recorded.The double-leg deep venous ultrasound was used seven days after operation.Results:The postoperative drainage[Distal femur group(263.5±86.5)ml,the proximal tibia group(288.1±71.5)ml]and the amount of invisible blood loss[Distal femur group(867.9±294.2)ml,the proximal tibea group(943.8±274.4)ml] in the experimental group were significantly less than those in the control group[drainage for the distal femur group(333.6±94.8)ml and the proximal tibia group(375.3±111.5)ml,while the invisible blood loss from distal femur group(1 182.7±256.2)ml and the proximal tibia group(1 174.0±292.1)ml],with significant difference(P<0.05).The number of blood transfusion in experimental group(Distal femur group 34.6%,the proximal tibia group 37.5%)was significantly less than that in control group(Distal femur group 66.7%,the proximal tibia group 73.3%),and the difference was statistically significant(P<0.05).There was no significant difference in postoperative thrombus incidence and postoperative limb circumference between the two groups(P>0.05).Conclusion:The local application of tranexamic acid intraoperatively in unilateral tumor knee arthroplasty patients could significantly reduce the amounts of postoperative blood loss and blood transfusion to avoid the perioperative anemia related complications.It is also safe,ecnomic and easy to use during surgery.
引文
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[4] Yang ZG,Chen WP,Wu LD.Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty:A meta-analysis[J].J Bone Joint Surg Am,2012,94(13):1153-1159.
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[6] Mutsuzaki H,Ikeda K.Intra-articular injection of tranexamic acid via drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty[J].J Orthop Surg Res,2012,29(7):32.
[7] Ma JH,Sun W,Gao FQ,et al.Blood loss and limb circumference changes in patients undergoing unilateral total knee arthroplasty after intra-articular injection of tranexamic acid:a randomized controlled trial[J].Journal of Clinical Rehabilitative Tissue Engineering Research,2014,18(35):5577-5582.
[8] Gao FQ,Li ZJ,Zhang K,et al.The preliminary analysis of hidden blood loss post total hip arthroplasty[J].Chin J Surg,2011,49 (12):1144-1147.
[9] Malawer MM,Chou LB.Prosthetic survical and clinical results with use of large-segment replacements in the treatment of highgrade bone sarcomas[J].J Bone Joint Surg Am,1995(77):1154-1165.
[10] Griffn AM,Parsons JA,Davis AM,et al.Uncemented tumor endoprostheses at the knee[J].Clin Orthop Relat Res,2005(438):71-79.
[11] XU Ming,ZHENG Kai,YU Xiuchun,et al.Endoprosthetic replacement of the proximal tibia for giant cell tumor of bone:A multicenter retrospective study[J].Chin J Bone and Joint,2017(2):87-91.[徐明,郑凯,于秀淳,等.肿瘤型膝关节假体置换治疗胫骨近端骨巨细胞瘤多中心回顾性研究[J].中国骨与关节杂志,2017(2):87-91.]
[12] CHEN Guanhong,QIN Lei,HUANG Hui,et al.Intravenous versus articular injection of tranexamic acid for reducing hemorrhage after unilateral total knee arthroplasty[J].Chinese Journal of Tissue Engineering Research,2018(3):350-355.[陈冠宏,秦磊,黄辉,等.氨甲环酸两种用药途径减少单侧全膝关节置换后出血的比较[J].中国组织工程研究,2018(3):350-355.]
[13] Tzatzairis TK,Drosos GI,Kotsios SE,et al.Intravenous vs topical tranexamic acid in total knee arthroplasty without tourniquet application:A randomized controlled study[J].J Arthroplasty,2016,31(11):2465-2470.
[14] Rasouli MR,Parvizi J.Tranexamic acid in total joint arthroplasty:Efficacy and safety[J].Arch Bone Joint Surg,2015,3(1):1.
[15] Royston D.Blood-sparing drugs:aprotinin,tranexamic acid,and epsilon-aminocaproic acid[J].Int Anesthesiol Clin,1995(33):155-179.
[16] Choi YJ,Ra HJ.Patient satisfaction after total knee arthroplasty[J].Knee Surg Relat Res,2016,28(1):1-15.
[17] Panteli M,Papakostidis C,Dahabreh Z,et al.Topical tranexamicacid in total knee replacement:A systematic review and meta-analysis[J].Knee,2013(20):300-309.
[18] Jang B,Kao M,Bohm MT,et al.Intra -articular injection oftranexamic acid to reduce blood loss after total knee arthroplasty[J].J Orthop Surg (Hong Kong),2014,22(2):146-149.
[19] Sanz-Reig J,Parra RB,Ferrández MJ,et al.Single intravenous tranexamic acid dose to reduce blood loss in primary total knee replacement[J].Rev Esp Cir Ortop Traumatol,2016,60(2):106-112.
[20] Chen JY,Chin PL,Moo IH,et al.Intravenous versus intra-articular tranexamic acid in total knee arthroplasty:A double-blinded randomised controlled noninferiority trial[J].Knee,2016,23(1):152-156.
[2] CRASH-2 Trial Collaborators,Shakur H,Roberts I,et al.Effects of tranexamic acid ondeath,vascular occlusive events,and blood transfusion in trauma patients with significant haemorrhage (CRASH -2):Arandomised,placebo-controlled trial[J].Lancet,2010,376(9734):23-32.
[3] Bagsby DT,Samujh CA,Vissing JL,et al.Tranexamic acid decreases incidence of blood transfusion in simultaneous bilateral total knee arthroplasty[J].J Arthroplasty,2015,30(12):2106-2109.
[4] Yang ZG,Chen WP,Wu LD.Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty:A meta-analysis[J].J Bone Joint Surg Am,2012,94(13):1153-1159.
[5] Sa-Ngasoongsong P,Channoom T,Kawinwonggowit V,et al.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[J].Orthop Rev(Pavia),2011(3):e12.
[6] Mutsuzaki H,Ikeda K.Intra-articular injection of tranexamic acid via drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty[J].J Orthop Surg Res,2012,29(7):32.
[7] Ma JH,Sun W,Gao FQ,et al.Blood loss and limb circumference changes in patients undergoing unilateral total knee arthroplasty after intra-articular injection of tranexamic acid:a randomized controlled trial[J].Journal of Clinical Rehabilitative Tissue Engineering Research,2014,18(35):5577-5582.
[8] Gao FQ,Li ZJ,Zhang K,et al.The preliminary analysis of hidden blood loss post total hip arthroplasty[J].Chin J Surg,2011,49 (12):1144-1147.
[9] Malawer MM,Chou LB.Prosthetic survical and clinical results with use of large-segment replacements in the treatment of highgrade bone sarcomas[J].J Bone Joint Surg Am,1995(77):1154-1165.
[10] Griffn AM,Parsons JA,Davis AM,et al.Uncemented tumor endoprostheses at the knee[J].Clin Orthop Relat Res,2005(438):71-79.
[11] XU Ming,ZHENG Kai,YU Xiuchun,et al.Endoprosthetic replacement of the proximal tibia for giant cell tumor of bone:A multicenter retrospective study[J].Chin J Bone and Joint,2017(2):87-91.[徐明,郑凯,于秀淳,等.肿瘤型膝关节假体置换治疗胫骨近端骨巨细胞瘤多中心回顾性研究[J].中国骨与关节杂志,2017(2):87-91.]
[12] CHEN Guanhong,QIN Lei,HUANG Hui,et al.Intravenous versus articular injection of tranexamic acid for reducing hemorrhage after unilateral total knee arthroplasty[J].Chinese Journal of Tissue Engineering Research,2018(3):350-355.[陈冠宏,秦磊,黄辉,等.氨甲环酸两种用药途径减少单侧全膝关节置换后出血的比较[J].中国组织工程研究,2018(3):350-355.]
[13] Tzatzairis TK,Drosos GI,Kotsios SE,et al.Intravenous vs topical tranexamic acid in total knee arthroplasty without tourniquet application:A randomized controlled study[J].J Arthroplasty,2016,31(11):2465-2470.
[14] Rasouli MR,Parvizi J.Tranexamic acid in total joint arthroplasty:Efficacy and safety[J].Arch Bone Joint Surg,2015,3(1):1.
[15] Royston D.Blood-sparing drugs:aprotinin,tranexamic acid,and epsilon-aminocaproic acid[J].Int Anesthesiol Clin,1995(33):155-179.
[16] Choi YJ,Ra HJ.Patient satisfaction after total knee arthroplasty[J].Knee Surg Relat Res,2016,28(1):1-15.
[17] Panteli M,Papakostidis C,Dahabreh Z,et al.Topical tranexamicacid in total knee replacement:A systematic review and meta-analysis[J].Knee,2013(20):300-309.
[18] Jang B,Kao M,Bohm MT,et al.Intra -articular injection oftranexamic acid to reduce blood loss after total knee arthroplasty[J].J Orthop Surg (Hong Kong),2014,22(2):146-149.
[19] Sanz-Reig J,Parra RB,Ferrández MJ,et al.Single intravenous tranexamic acid dose to reduce blood loss in primary total knee replacement[J].Rev Esp Cir Ortop Traumatol,2016,60(2):106-112.
[20] Chen JY,Chin PL,Moo IH,et al.Intravenous versus intra-articular tranexamic acid in total knee arthroplasty:A double-blinded randomised controlled noninferiority trial[J].Knee,2016,23(1):152-156.