| Background:Knee osteoarthritis is a chronic degenerative disease in middle and old age group. Artificial knee arthroplasty(TKA) as a mature technology has been widely used in the treatment of middle and late stage of knee osteoarthritis, and its efficacy has been proved to be accurate and reliable. After TKA, the amount of bleeding in the bone surface and medullary cavity is large, and the blood transfusion is inevitable in some patients. But at present, the clinical use of blood tension and difficult to avoid the risk of infection in the window period of blood transfusion, has been a problem for patients and clinicians. Therefore, it has been hoped to find a new method to reduce the blood loss caused by surgical trauma, reduce the probability of blood transfusion and the risk of blood transfusion. At present domestic and foreign reports on intravenous TKA operation or topical use of tranexamic acid can reduce postoperative blood loss. But the intraoperative tranexamic acid can be used to obtain the best effect there is no unified opinion. For local intra-articular and intravenous effect which method is better for tranexamic acid has also been a lot of controversy. Local intra-articular use tranexamic acid required in operation after the end of most of negative pressure drainage tube clip for a period of time, its purpose is to reduce the loss of local tranexamic acid, and as far as possible to produce the largest drug effect. So this study clip closed drainage tube 3 hours by intra-articular injection of local tranexamic acid, to try to extend the time of drug action.Purpose:Comparison of total knee arthroplasty with small dose of local infiltration of the clinical curative effect of tranexamic acid use method.Method:We will 2013.4-2014.11 Department of Orthopaedics; Suzhou University; Changshu first people’s Hospital of 66 cases of knee osteoarthritis of the quasi unilateral artificial total knee arthroplasty patients, among them, there were 18 male patients for women in 48 cases. We randomly divided them into three groups, 21 cases in Group A, 23 cases ingroup Band 22 cases in group C. Of patients of group A were used in local infiltration of tranexamic acid treatment, after the end of the installation of prosthesis and surface suture support belt, clipping negative pressure drainage, 1 g tranexamic acid injection is injected directly into the joint cavity. After operation, the drainage tube was kept for 3 hours. B group of patients with Yu Songkai tourniquet 10 minutes before the intravenous drip of tranexamic acid 1g, after the same clipping drainage for 3 hours. C group without the use of tranexamic acid, after the same clipping drainage for 3 hours. According to the amount of bleeding, the patient’s heartbeat, blood pressure and other general situation to consider whether or not the blood transfusion.Negative pressure drainage tube was removed at 24 hours after operation in the three groups. Patients with postoperative when the blood HB(less than 70 g / L for transfusion red hanging correction of anemia, between 70 to 80, according to patients when the general situation and the existence of obvious symptoms of anemia, decide whether to transfusion therapy. The recorded data are as follows: Intraoperative blood loss,96 patients with preoperative and postoperative Hb and HCT, postoperative 24 h vacuum tube bloody drainage, preoperative and postoperative 3 hours after coagulation index changes(including D2 dimer, fibrinogen, activated partial thromboplastin time and prothrombin time), postoperative patients limb swelling degree change(patellar 10 cm diameter change), postoperative limb pain score changes, postoperative need transfusion patient number and volume of blood transfusion, postoperative 2 weeks in the HSS knee score, lower extremity venous thrombosis or pulmonary embolism.Using SPSS19.0(SOCIAL SCIENCE statistical software package) to analyze the clinical data of the above data. The measurement data as tested with normal distribution,using(χ + S) said. A single factor analysis was used to compare the data between two two groups. Three groups of patients with gender, blood transfusion ratio using chi square test, If the minimum theoretical frequency is less than 5, the data is analyzed by using the Fisher exact probability method. such as P<0.05 is considered a significant difference.Result:①After the operation of 24 h, the blood flow of in A group was compared with that of B group, the 24 h group was C, and the P value was <0.05, which was statistically significant.②96h after, the hidden blood loss was compared with the results of the A and B groups, the hidden blood loss was compared with the results of P>0.05, no significant. In the A group, the B group were compared with the C group, the P value was <0.05, and it was statistically significant.③The total blood loss after 96 h was compared with the results: the total blood loss in group B, C, A, the P value was <0.05, were statistically significant.④The A group B group C group FDPS, between the three groups PT, APTT comparison, P values were >0.05, no statistical significance. The results of two, D, and P>0.05 were not statistically significant in A group and B group. The results of A D two in B group were compared with that of C group, P value was <0.05, and it was statistically significant.⑤The postoperative limb on days 1 and 4 days swelling degree changes compared with the group A and group B postoperative limb patellar 10 cm perimeter degree change comparison results, P > 0.05, no statistically significant. In the A group, the B group were compared with the C group, the P value was <0.05, and it was statistically significant.⑥The postoperative limb 24 h, 48 h, 96 hours resting pain change scores compared with the A, B and C group among the three groups postoperative limb pain score results, P > 0.05, no statistically significant.⑦The knee Hss score was compared in 2 weeks after operation. The results showed that the Hss score of C group was 2 weeks after operation, and the P value was >0.05, and the B values were not statistically significant.⑧The proportion of patients with blood transfusion was the result of the comparisonbetween A and B groups, and the proportion of patients with blood transfusion was the result of the comparison, P>0.05, no statistical significance. In the A group, the B group were compared with the C group, the P value was <0.05, and it was statistically significant.Conclusion:The probability of total knee arthroplasty in the intra-articular local use of tranexamic acid can reduce postoperative bleeding and blood transfusion. And it does not increase the probability of venous thromboembolism after surgery. |
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