| Objective: The medial open wedge-shaped high tibial osteotomy to treat knee osteoarthritis is gradually accepted by doctors and young patients,but massive bleeding on the osteotomy surface and soft tissue may bring some related complications.For some orthopedics commonly used methods to reduce perioperative blood loss,the application of the medial open wedge tibial high osteotomy is currently There are few related studies at home and abroad.This article will discuss the clinical application of different administration methods of tranexamic acid(TXA),a commonly used hemostatic drug in orthopedics,in the treatment of varus knee osteoarthritis by medial open wedge-shaped high tibial osteotomy(MOWHTO)Efficacy.Methods: A retrospective analysis of 95 patients with varus knee osteoarthritis who underwent MOWHTO from February 2017 to February 2019 met the inclusion criteria.According to the TXA usage,they were divided into: Group A(not used,n=30),group B(intravenous infusion,n=34,2g TXA dissolved in 100 ml saline 30 min before surgery),group C(topical application,n=31,2g TXA dissolved in 20 ml saline,the incision was closed and then injected into the incision by the drainage tube).Record operation time,intraoperative blood loss,postoperative drainage,postoperative blood transfusion,incision and other complications,and symptomatic venous thromboembolism(VTE),calculated the patient’s total blood loss based on blood volume,preoperative hemoglobin concentration and postoperative minimum hemoglobin concentration;record 1 day before surgery,the first,third,and sixth postoperative month hospital for special surgery knee score(HSS score)and Visual Analogue Scale(VAS)1 day before surgery,the first,third postoperative day,the first,third,and sixth postoperative month.Results:There was no statistically significant difference in intraoperative blood loss and operation time between groups of patients(P>0.05).In terms of postoperative complications,one case of subcutaneous hematoma occurred in group A,which was cured after a second operation to clean up,while group B appeared One case of poor incision healing was cured after timely dressing change.There was no significant difference in postoperative incision complications and symptomatic thromboembolic events in the three groups(P<0.05).There was no blood transfusion and no vascular events occurred.The postoperative total drainage volume of group B and C was less than that of group A,and the difference was statistically significant.The total blood loss of group A during the perioperative period was more than that of group B and C,and the difference was statistically significant [(712.04±124.35ml)vs(431.26±88.15ml)vs(488.59±149.16ml),PAB <0.05,PAC <0.05,PBC>0.05)].One year after operation,X-rays showed that all patients in the three groups were bone healed,and there was no obvious loss of force lines,and the internal fixation position was good.Conclusion: 1.Both intravenous or topical TXA can reduce blood loss during MOWHTO perioperative period,and does not increase the risk of postoperative venous thromboembolism,but the effect of intravenous and topical application on reducing perioperative blood loss There is no obvious difference.2.The way of administration of Tranexamic acid has no significant effect on pain at 3 and 6 months after surgery,and can reduce knee pain at 1 day,3 days and 1 month after surgery,but it has no obvious relationship with the way of administration.3.The way of administration of Tranexamic acid has no significant effect on the function of the affected limb at 3 and 6months after surgery,but it can improve the function of the knee joint at 1 month after surgery. |
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