不同氨甲环酸应用方式对初次单侧全髋关节置换术的止血效果、安全性及临床疗效的影响  

Effect of different applications of tranexamic acid on hemostasis, safety and clinical efficacy in primary unilateral total hip arthroplasty

作　　者：孟庆奇 胡莉琼 杨伟民 崔树廷[2] 奉振成 王敏[1] 李斯明[1] MENG Qingqi;HU Liqiong;YANG Weimin;CUI Shuting;FENG Zhencheng;WANG Min;LI Siming(Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou 510220;Department of Orthopedics, The Second Hospital of Liaocheng, Taishan Medical College, Liaocheng 252000, Shandong, China)

机构地区：[1]暨南大学医学院附属广州红十字会医院骨科,广州510220 [2]泰山医学院附属聊城二院骨科,山东聊城252000

出　　处：《中华骨与关节外科杂志》2019年第7期524-527,550,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:不同氨甲环酸应用方式对髋关节置换术后的临床效果,包括早期下地行走等及相关并发症发生情况的影响尚无统一认识。目的:对比分析术中不同氨甲环酸应用方式对初次单侧全髋关节置换术的止血效果、安全性及临床疗效的影响。方法:回顾性分析2015年9月至2017年9月间收治的170例初次单侧全髋置换患者,按氨甲环酸不同应用方式分为3组:对照组46例患者均未应用氨甲环酸;静脉组54例患者静脉滴注氨甲环酸;关节腔组70例患者关节腔局部应用氨甲环酸。记录、观察并比较3组患者术后行走距离、术后24 h引流管拔出率、血红蛋白水平、引流量、输血率、并发症发生情况、美国特种外科医院(HSS)评分。结果:所有患者随访3~6个月,平均随访(4.7±0.6)个月。静脉组、关节腔组患者术后第1天、第2天行走距离均长于对照组患者,且差异均有统计学意义(P均<0.01),而静脉组与关节腔组患者之间差异均无统计学意义;3组患者术后第3天行走距离差异均无统计学意义。静脉组、关节腔组患者术后24 h引流管拔出率、术后3 d血红蛋白水平均高于,输血率均低于对照组患者,且差异均有统计学意义(P均<0.05或0.01),而静脉组与关节腔组患者之间差异无统计学意义。术前3组患者血红蛋白水平差异无统计学意义。对照组患者引流量大于关节腔组患者,且差异有统计学意义(P<0.01),而对照组与静脉组、静脉组与关节腔组患者之间差异均无统计学意义。静脉组、关节腔组患者术后伤口局部血肿形成发生率均低于对照组患者,且差异有统计学意义(P均<0.05),而静脉组与关节腔组患者之间差异无统计学意义。3组患者血栓形成、伤口红肿浅表感染发生率差异均无统计学意义。无一例患者发生伤口深部感染。术前、术后1个月、术后3个月3组患者HSS评分差异均无统计学意义。结论:氨甲环酸的局Background: The most appropriate application of tranexamic acid (TXA) during hip joint replacement surgery is still in dispute. Objective: To compare clinical efficacy and safety of different application methods of TXA in primary unilateral total hip arthroplasty (THA). Methods: A total of 170 patients undergoing primary unilateral THA between September 2015 and September 2017 were enrolled in this retrospective study. They were divided into three groups: control group (n=46, no TXA was given), intravenous TXA group (n=54, TXA was given by intravenous drop), and intra-articular TXA group (n=70, TXA was topically intra-articular injected). The early ambulation, 2 4 - hour postoperative drainage rate, hemoglobin level, drainage volume, blood transfusion rate, complications, hip HARRIS scores (HSS) were compared in groups. Results: The mean duration of follow- up was (4.7±0.6) months (range,3- 6 months) in all the patients. The walking distance of early ambulation of intravenous TXA group and intra-articular TXA group were significantly longer than that of the control group in the 1st and 2nd day after surgery (P<0.01), but there was no difference between intravenous TXA group and intra-articular TXA group. In the 3rd day postoperatively, there was no significant difference in early ambulation among the 3 groups. 24-hour postoperative drainage rate and hemoglobin level within 3d after THA in intravenous TXA group and intra-articular TXA group were significantly higher than those in control group (P<0.05, P<0.01), but there was no significant difference in the two parameters between intravenous TXA group and intra-articular TXA group. The drainage volume in control group was significantly higher than that in intra-articular TXA group (P<0.01). The incidence of wound hematoma in control group were significantly higher than that in the other two groups (P<0.05), but there was no difference between intravenous TXA group and intra-articular TXA group. There was no significant difference in the incidence of thrombosis or

关 键 词：氨甲环酸 关节成形术 置换 髋 输注 静脉内 注射 关节内 

分 类 号：R687.4[医药卫生—骨科学]