氨甲环酸关节腔周围注射与关节腔灌注在全膝关节置换术中的疗效比较  

Hemostatic effect of tranexamic acid by peri-articular injection versus intra-articular perfusion during total knee arthroplasty:A randomized controlled trial

作　　者：张军[1] 满家政 冯仕明[1] 马超[1] 王涛[1] ZHANG Jun;MAN Jiazheng;FENG Shiming;MA Chao;WANG Tao(Department of Orthopaedics,Xuzhou Central Hospital,Southeast University,Xuzhou 221009,China)

机构地区：[1]东南大学附属徐州市中心医院骨科,江苏徐州221009

出　　处：《实用医学杂志》2022年第14期1788-1792,共5页The Journal of Practical Medicine

基　　金：江苏省高层次卫生人才“六个一工程”(编号:LGY2020028)。

摘　　要：目的比较全膝关节置换术中氨甲环酸关节腔周围注射与关节腔灌注在减少术后出血的临床疗效。方法选取2018年6月至2020年2月我院收治140例膝关节骨性关节炎行全膝关节置换术患者,依纳入与排除标准筛选出132例随机分为观察组66例(关节腔周围注射)和对照组66例(关节腔灌注),比较两组患者术后总失血量、24 h引流量、术后第3天隐性失血量,以及术后第5天、第10天NRS疼痛评分、大腿、髌上及小腿周径。结果观察组和对照组总失血量和术后第3天隐性失血量差异无统计学意义(P>0.05);而术后24 h引流量观察组明显多于对照组,差异有统计学意义(P<0.05)。术后第5天及第10天两组NRS疼痛评分、下肢肿胀差异无统计学意义(P>0.05);两组术后血栓并发症差异无统计学意义(P>0.05)。结论全膝关节置换术中关节腔周围注射氨甲环酸在减少术后出血方面并没有优于关节腔灌注,但考虑引流管存在的风险,关节腔周围注射氨甲环酸仍是不错的选择。Objective To compare the clinical efficacy of tranexamic acid by peri-articular injection vs.intra-articular perfusion for reducing postoperative bleeding during total knee arthroplasty.Methods A total of140 patients with knee osteoarthritis who were admitted into our hospital from June 2018 to February 2020 for total knee arthroplasty were selected and randomly divided into observation group and control group in equal number,treated with peri-articular injection and intra-articular perfusion with tranexamic acid,respectively.The two groups were compared in terms of total postoperative blood loss,24-hour drainage volume and hidden blood loss at day 3postoperatively,as well as NRS scores,circumference of thigh,superior patella and calf at days 5 and 10 postoperatively.Results There were no significant differences in total blood loss and hidden blood loss at day 3 after operation between the groups.The 24-hour drainage volume of the observation group was significantly higher than that of the control group.There were no significant differences in the NRS score and lower limb swelling between the two groups at days 5 and 10 after operation.There was no significant difference in postoperative thrombotic complications between the two groups.Conclusion During total knee arthroplasty,peri-articular injection with tranexamic acid is as effective in reducing postoperative bleeding as intra-articular perfusion with the acid.However,it is still a good choice in consideration of the drainage tube-involved risks.

关 键 词：氨甲环酸 全膝关节置换术 关节腔周围注射 关节腔灌注 

分 类 号：R684.3[医药卫生—骨科学]