不同实施方案下氨甲环酸应用于胫骨高位截骨术中疗效的网状Meta分析  

Tranexamic acid in high tibial osteotomy under different procedures:a network Meta-analysis

作　　者：张可[1] 刘博 成凯[1] 贾健[1] ZHANG Ke;LIU Bo;CHENG Kai(Department of Joint Surgery,Linfen People's Hospital,Linfen,Shanxi(041000),China)

机构地区：[1]临汾市人民医院,山西临汾041000

出　　处：《中国中西医结合外科杂志》2023年第2期186-191,共6页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：临汾市人民医院科技创新基金(T20210401048)。

摘　　要：目的:利用网状Meta分析系统评价不同实施方案下氨甲环酸(TXA)应用于胫骨高位截骨术(HTO)中的疗效。方法:在Cochrane library、PubMed、Embase、CNKI、万方数据库和中国生物医学文献数据库系统检索截至2021年12月前已发表的有关评价TXA用于HTO的有效性和安全性的中英文文献,观测指标包括:围手术期总失血量、术后总引流量、切口并发症、血栓形成情况及输血率。采用Stata 16.0进行网状Meta分析。结果:共纳入13项临床研究,包括4篇随机对照试验(RCTs)和9篇回顾性病例对照研究(CCTs),共计1311例患者。网状Meta分析显示:静脉注射TXA可以降低围手术期总失血量和术后总引流量,使用止血带或联合局部和静脉注射TXA并没有减少总失血量,但使用止血带显著增加了术后总引流量。单纯静脉注射TXA可以降低术后切口并发症发生率,各实施方案下患者静脉血栓形成和输血率均无统计学差异。结论:TXA可以降低HTO患者术后总失血量和引流量。推荐静脉注射TXA用于HTO术中血液管理,且不推荐使用止血带。Objective To evaluate the differences in the efficacy of tranexamic acid(TXA)applied in high tibial osteotomy(HTO)under different implementation protocols by using network Meta-analysis.Methods All published literature in English and Chinese on the evaluation of the efficacy and safety of TXA for HTO were searched from the Cochrane Library,PubMed,Embase,CNKI,Wanfang database,and the Chinese Biomedical Literature Database system.The observations included:total perioperative blood loss,total postoperative drainage,wound complications,thrombotic events,and blood transfusion rate.A network Meta-analysis was performed using Stata 16.0.Results A total of 13 clinical studies,including 4 randomized controlled trials(RCTs)and 9 retrospective case-control studies(CCTs),with a total of 1311 patients were included.The results of the network Meta-analysis showed that intravenous TXA reduced total perioperative blood loss and total postoperative drainage,and the use of tourniquets or combined topical and intravenous TXA did not reduce total blood loss.However,the use of tourniquets significantly increased total postoperative drainage.Intravenous TXA alone reduced the rate of postoperative wound complications,but there were no statistical differences in the rates of thrombotic events and blood transfusion rate in patients under each implementation option.Conclusions TXA can reduce total postoperative blood loss and drainage in HTO patients.Intravenous TXA alone is recommended for intraoperative blood management in HTO,and tourniquets are not recommended.

关 键 词：失血 引流量 胫骨高位截骨术 氨甲环酸 止血带 网状Meta分析 

分 类 号：R687.3[医药卫生—骨科学]