全膝关节置换术关节腔加压灌注的临床效果  

Clinical outcomes of pressuring intraarticular perfusion of tranexamic acid-saline at end of total knee arthroplasty

作　　者：姜波[1] 付新生[1] 蔡翔宇[1] 张其川[1] 崔银江 JIANG Bo;FU Xin-sheng;CAI Xiang yu;ZHANG Qi-chuan;CUI Yin-jang(Department of Orthopedics,Central Hospital of Xinxiang City,Xinxiang 453000 China)

机构地区：[1]新乡市中心医院骨关节科,河南新乡453000

出　　处：《中国矫形外科杂志》2021年第2期114-118,共5页Orthopedic Journal of China

基　　金：河南省科技发展项目(编号:152300410012)。

摘　　要：[目的]探讨全膝关节置换术(total knee arthroplasty, TKA)术后采用关节腔加压灌注的临床效果。[方法] 2017年2月~2018年12月,纳入TKA手术的患者176例并依据随机数字表法分为两组;其中92例于TKA术毕加压灌注氨甲环酸生理盐水,84例术毕常压注入氨甲环酸生理盐水。比较两组患者的围手术期、随访与血液检查资料。[结果]加压组总失血量、术后显性失血量及术后隐性失血量均显著低于常压组(P<0.05)。术后1周,加压组的VAS和HSS评分均显著优于常压组(P<0.05);但末次随访时,两组间VAS和HSS评分的差异无统计学意义(P>0.05)。辅助检查方面,彩超检查显示,加压组浅静脉血栓2例,深静脉血栓1例;常压组浅静脉血栓3例,深静脉血栓3例。术后1周加压组的Hb和HCT均显著高于常压组(P<0.05)。[结论] TKA术毕关节腔加压灌注氨甲环酸生理盐水可降低术后隐性出血量,有利于术后关节功能恢复,且不增加术后不良反应风险。[Objective] To explore the effect of pressuring intraarticular perfusion of tranexamic acid(TXA)-saline at end of total knee arthroplasty(TKA) on the clinical outcomes. [Method] From February 2017 to December 2018, a total of 176 patients who were undergoing TKA were enrolled in this study, and divided into two groups based on the consequence of patient-doctor communication. Of them,92 patients had pressuring intraarticular perfusion of TXA-saline at end of TKA, while the remaining 84 patients had intraarticular TXAsaline perfusion under normal pressure at end of surgery. The patients in the two groups were compared regarding documents of the perioperative period, follow-up and assistant examinations. [Results] The pressuring group proved significantly superior to the normal pressure group in total blood loss, postoperative dominant blood loss and recessive blood loss(P<0.05). At 1 week after operation the pressuring group was significantly superior to the normal pressure group in VAS and KSS scores(P<0.05), although no statistical differences were found in the aforesaid scores between them at the latest follow up(P>0.05). In term of assistant examinations, the color sonography revealed that superficial venous and deep venous thrombus were 2 and 1 case in the pressuring group, whereas 3 and 3 in the normal pressure group respectively. In addition, the pressuring group had significantly higher levels of Hb and HCT than the normal pressure group at 1 week after operation(P<0.05). [Conclusion] The pressuring intraarticular perfusion of TXA-saline at end of total knee arthroplasty(TKA)does reduce postoperative blood loss, and facilitate functional recovery without increasing the risk of adverse reactions.

关 键 词：全膝关节置换术 关节腔加压灌注 失血量 关节功能 

分 类 号：R687.4[医药卫生—骨科学]