冷敷联合氨甲环酸对全膝关节置换术后早期局部反应的影响  

Effect of cold compress combined with tranexamic acid on early local reaction after total knee arthroplasty

作　　者：张晋宁 杨天翔 张博文 程萌旗[2] 陈德胜 ZHANG Jinning;Yang Tianxiang;ZHANG Bowen;CHENG Mengqi;Chen Desheng(School of Clinical Medicine,Ningxia Medical University,Yinchuan 750004,China;Department of Joint Surgery,the Sixth Affiliated People′s Hospital of Shanghai Jiaotong University,Shanghai 200233,China;Department of Orthopedics,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China)

机构地区：[1]宁夏医科大学临床医学院,宁夏银川750004 [2]上海交通大学附属第六人民医院关节外科,上海200233 [3]宁夏回族自治区人民医院骨科,宁夏银川750002

出　　处：《宁夏医学杂志》2023年第5期397-400,共4页Ningxia Medical Journal

基　　金：国家自然科学基金资助项目(81760405,81760395,82060408);宁夏回族自治区重点研发计划项目(2021BEG03049);宁夏留学人员创新创业项目(2020-75);宁夏回族自治区自然科学基金资助重点项目(2018AAC02013);宁夏医科大学校级课题重点项目(XZ2018014);宁夏高等学校一流学科建设资助项目(NXYLXK2017A05)。

摘　　要：目的研究冷敷联合氨甲环酸(TXA)对全膝关节置换术(TKA)术后早期局部反应的影响。方法采用回顾性分析方法,选取初次接受全膝关节置换术的135例患者纳入本研究,随机分为A、B、C组。A组45例患者TKA术前静滴TXA 1 g,B组45例患者在静滴TXA的基础上,关闭切口时关节腔注入TXA 1 g,C组45例在联合TXA组的基础上术后进行冷敷治疗。比较3组患者术后早期疼痛、肿胀、关节活动度情况。结果A组,B组、C组术后引流量更低,且C组术后低于B组,差异有统计学意义(P<0.05)。A组,B组、C组术后24、48 h疼痛视觉模拟评分(VAS)更低,且C组术后24、48 h疼痛评分低于B组,差异有统计学意义(P<0.05)。A组,B组、C组术后3、7 d关节活动度(ROM)更高,且C组术后3、7 d ROM明显高于B组,差异有统计学意义(P<0.05)。较A组,B组、C组术后3、7 d两股部周径差更低,且C组术后3、7 d低于B组,差异有统计学意义(P<0.05)。3组患者所有手术均顺利完成,无任何不良反应。围手术期间所有患者均无心脑血管意外,无动静脉栓塞、死亡等意外发生。所有患者术区愈合良好,无严重瘀斑、冻伤等意外发生。结论全膝关节置换术后冷敷联合TXA可有效减轻患者术后术区肿胀、出血、疼痛,并且有利于患者术后关节活动度恢复,有助于患者术后康复锻炼,加强患者康复信心。Objective To study the effect of cold compress combined with tranexamic acid(TXA)on early local reaction after total knee arthroplasty(TKA).Methods The clinical data of 135 patients who underwent total knee arthroplasty for primary unilateral TKA for end stage knee osteoarthritis were included in this study.The patients were randomly divided into group A,group B and Group C according to treatment methods.Group A received intravenous infusion of 1 g TXA before TKA.In group B,1 g TXA was injected into the joint cavity when the incision was closed on the basis of the treatment in group A.Group C was treated with continuous cold compress after TKA on the basis of group B.The intraoperative blood loss,operative time,postoperative drainage volume,pain score,range of motion(ROM)and circumference difference of the two extremities were compared among the three groups.Results There were no significant differences in intraoperative blood loss and operation time among the three groups(P>0.05).Compared with group A,postoperative drainage volume in groups B and C was lower,and group C was lower than group B after operation,the differences were statistically significant(P<0.05).Compared with group A,the pain scores of group B and C were lower at 24 and 48 hours after operation(P<0.05).The ROM in group C at 3 and 7 days after operation was significantly higher than that in group B(P<0.05).Compared with group A,the difference in circumference between the two thighs of circumference group B and C were lower,and group C was lower than that in group B at 3 and 7 days after operation(P<0.05).Conclusion Cold compress combined with TXA can effectively relieve the early postoperative local reaction of TKA,and relieve postoperative pain and reduce bleeding,improve the range of motion of joints,and promote their rapid recovery.

关 键 词：全膝关节置换术 冷敷 氨甲环酸 局部反应 

分 类 号：R687.4[医药卫生—骨科学]