骨蜡减少全膝关节置换术术后失血的相关研究  

Efficacy of bone wax in reducing postoperative blood loss in total knee arthroplasty.

作　　者：张庭 贾丙申[2] 邓迎杰 ZHANG Ting;JIA Bin-shen;DENG Ying-jie(Department of Jiont Surgery,Nanhai People's Hospital Affiliated to Southern Medical University,Foshan 528200,Guangdong,CHINA;Department of Joint Trauma Surgery,the First Affiliated Hospital of Hainan Medical College,Haikou 570102,Hainan,CHINA;Department of Joint Surgery,Traditional Chinese Medical Hospital of Xinjiang Autonomous Region Affiliated to Xinjiang Medical University,Urumqi 830001,Xinjiang,CHINA)

机构地区：[1]佛山市南海区人民医院关节外科,广东佛山528200 [2]海南医学院第一附属医院关节创伤外科,海南海口570102 [3]新疆自治区中医院关节外科,新疆乌鲁木齐830001

出　　处：《海南医学》2021年第6期757-759,共3页Hainan Medical Journal

基　　金：广东省医学科研基金(编号:B2019166)。

摘　　要：目的评估骨蜡在减少全膝关节置换术患者术后失血量的有效性。方法回顾性分析佛山市南海区人民医院关节外科、海南医学院第一附属医院关节创伤外科、新疆自治区中医院关节外科2017年3月至2019年6月行单侧全膝关节置换术中应用骨蜡止血的50例患者(骨蜡组)和未使用骨蜡治疗的50例患者(对照组)的临床资料。比较两组患者术中失血量、术后引流量、隐形失血量、显性失血量、总失血量、输血比例、临床治疗效果(膝关节HSS评分)及术后并发症。结果两组患者的年龄、身体质量指数(BMI)、术前血红蛋白(Hb)、红细胞压积(Hct)、血小板(PLT)、美国特种外科医院膝关节评分(HSS评分)、手术时间、术中止血带时间、术中失血量比较差异均无统计学意义(P>0.05);骨蜡组患者术后24 h Hb水平下降(1.6±0.9)g/dL,明显少于对照组的(2.1±1.1)g/dL,而术后72 h Hb水平下降(2.7±1.1)g/dL,也明显少于对照组的(3.6±1.2)g/dL,差异均有统计学意义(P<0.05);骨蜡组患者术后72 h的总出血量为987.9 mL,明显少于对照组的1183.5 mL,差异有统计学意义(P<0.05);术后随访3个月,骨蜡组患者没有发生与使用骨蜡相关的不良事件。结论全膝关节置换术中应用骨蜡可以有效减少术后失血量,能维持较高的Hb水平,而且未增加术后并发症的风险。Objective To evaluate the efficacy of bone wax in reducing blood loss after total knee replacement.Methods The clinical data of 50 patients with hemostasis received bone wax during unilateral total knee arthroplasty(bone wax group)and 50 patients without bone wax treatment(control group),who admitted to Department of Joint Surgery of Nanhai People's Hospital Affiliated to Southern Medical University,Department of Joint Trauma Surgery of the First Affiliated Hospital of Hainan Medical College,Department of Joint Surgery,Traditional Chinese Medical Hospital of Xinjiang Autonomous Region Affiliated to Xinjiang Medical University from March 2017 to June 2019,were retrospectively analyzed.Intraoperative blood loss,postoperative drainage,invisible blood loss,apparent blood loss,total blood loss,blood transfusion ratio,clinical treatment effect(knee HSS score),and postoperative complications of the two groups were compared.Results There was no significant difference in the age,body mass index(BMI),preoperative hemoglobin(Hb),hematocrit(Hct),platelets(PLT),knee joint score(HSS score),operation time,intraoperative hemostasis between the two groups of patients.The Hb level of patients in the bone wax group decreased by(1.6±0.9)g/dL at 24 hours after surgery,which was significantly less than(2.1±1.1)g/dL in the control group(P<0.05);the Hb level decreased(2.7±1.1)g/dL at 72 h after surgery,which was also significantly less than(3.6±1.2)g/dL in the control group(P<0.05);the total blood loss in the bone wax group at 72 h after surgery was 987.9 mL,which was significantly lower than 1183.5 mL in the control group,with statistically significant difference(P<0.05).After 3 months of follow-up,no adverse events related to the use of bone wax were observed in the bone wax group.Conclusion The application of bone wax in total knee replacement is safe and effective in reducing postoperative blood loss and maintaining high hemoglobin level.

关 键 词：骨蜡 全膝关节置换术 失血量 血红蛋白 有效性 

分 类 号：R687.4[医药卫生—骨科学]