Analysis Of Outcomes After Usage Of Tranexamic Acid During Total Knee Arthroplasty

With the development of society, people’s living standards continue to improve, the proportion of the elderly population is increasing year by year, the knee degenerative osteoarthritis seriously disturbed the majority of middle aged and old patients and healthy life. And the requirements of people’s living standards continue to improve, coupled with the knee joint replacement operation of artificial prosthesis material continuous upgrading of the progress and application of shape design of the prosthesis, total knee replacement in patients with postoperative prosthesis lifespan extending, more and more knee osteoarthritis patients chose the artificial knee joint replacement。As the preferred treatment method. The TKA operation is the effective solution in patients with knee osteoarthritis pain problem, very good reconstruction of the knee joint function, TKA has become one of the most common operation in the treatment of knee joint diseasesNowadays, artificial knee joint replacement is a very mature operation, but is still a big problem for clinical hemorrhage after operation. Patients with excessive bleeding often in need of homologous blood transfusion, easy to cause a variety of complications, including allergic reaction, bacterial / viral infections, and metabolic imblance..Although the application of tourniquet in operation will make less bleeding in operation, but the tourniquet will damage the intravascular coagulation system and fibrinolytic system, thus increasing the postoperative patients with hidden blood loss, make flow increased, the postoperative knee joint swelling significantly, also increases the risk of infection. With the level of clinical treatment technology continues to improve, various methods of reducing bleeding of patients, including tourniquet surgery, controlled hypotension, local injection "cocktail" solution method, as well as tranexamic acid(Tranexamic, acid, TXA, TNA) as the representative of the various anti fibrinolytic drugs application, to to reduce the bleeding of the objective.In recent years, with the number of total knee arthroplasty increase, how to reduce the amount of bleeding after TKA operation, has become the focus of attention of the clinicians.Tranexamic acid is a synthetic derivative of lysine, lysine its combination of plasmin and plasminogen to fibrin node connection parts of the binding site, can produce effect of competitive inhibition, and reversible damage to Lys plasminogen molecule binding sites form exert anti fibrinolysis effect of hemostasis, have trong.TXA has been in a number of surgical field application to reduce postoperative bleeding, including heart liver operation, operation, operation of Department of gynaecology, Department of Urology operation, oral surgical operation etc.The artificial knee joint replacement operation wound, osteotomy, therefore postoperative blood loss is relatively large, easily lead to postoperative deep vein thrombosis and pulmonary embolism.In order to reduce blood loss in total knee arthroplasty, clinicians try to use TXA in TKA, hope to be able to reach the purpose of hemostasis.Tranexamic acid initially in the late 80’s in the last century has been applied in Europe during TKA operation.There are many reports confirmed that intravenous and topical use of tranexamic acid can reduce bleeding.And not increasing the deep venous thrombosis(DVT) or pulmonary embolism(PE) incidence. This paper will discuss by prospective analysis of topical application of tranexamic acid on the effectiveness of reducing blood loss in peri operation period of TKAObjective: We will study and explore the effect of tranexamic acid in primary total knee arthroplasty postoperative blood loss From the blood loss during the operation, the variation of hemoglobin, joint activity and deep vein thrombosis and other aspect by the analysis of prospective joint surgery in our hospital 60 cases of osteoarthritis for artificial knee joint replacement patients Methods:The patients with knee osteoarthritis in 60 cases, eliminate anemia, coagulation dysfunction of patients, according to whether or not the use of tranexamic acid in the operation, were randomly divided into experimental group and control group, two groups of artificial knee joint replacement operation The experimental group(group A) in placing prosthesis after capsulorrhaphy before by tranexamic acid 100ml(1.0g/100ml), 0.2mg, 180 mg, morphine and ropivacaine epinephrine 10 mg formulated as a "cocktail" solution injected locally into the joint capsule and synovial tissues around The control group(group B) using physiological saline 100 ml, 0.2mg, 180 mg, morphine and ropivacaine epinephrine 10 mg hybrid "cocktail" solution Observation of postoperative bleeding, decrease in hemoglobin content, the number of cases of blood transfusion(rate), activity, subcutaneous ecchymosis situation and knee deep vein thrombosis, to clinical efficacy and safety analysis.Detection index: Analysis to evaluate the efficacy and safety of tranexamic acid after total knee arthroplasty blood loss by the observation of total knee arthroplasty in patients with occult blood loss after 24 h, 24 h drainage volume, blood transfusion rate, postoperative 24 h, 72 h changes in haemoglobin concentration, ecchymosis, pain degree, activity of knee joint, and there is no deep vein thrombosis, pulmonary embolism and other indicatorsResult:The differences between the two groups of patients admitted to the hospital with basic data has no statistical significance.Comparison of blood loss:Group A:803.6±265.4ml,Group B:1079.3±458.1ml,p<0.05,The two dominant blood loss and occult blood loss in group A were lower than that in group B.The concentration of hemoglobin: Postoperative 24 h Group A:( 11.3±0.9) g/l, Group B(10.2±0.7)g/l.Postoperative72 h :Group A(10.9±0.7)g/l,Group B(9.7±0.6) g/l,The group A is higher than group B,p<0.05.Comparison of blood transfusion rate: Group A 0.03,Group B 0.20,p<0.05,Subcutaneous ecchymosis, pain and knee flexion degree in group A were better than group B. A, B two groups were no deep vein thrombosis, pulmonary embolism, two groups of patients without symptoms of infection.conclusions: Artificial total knee arthroplasty in topical application of tranexamic acid can effectively reduce postoperative blood loss, reduced postoperative pain and joint swelling, accelerate the function recovery of knee flexion.