Observe The Hemostatic Effect Of Intravenous Combined Topical Application Of Tranexamic Acid In Primary Unilateral Total Hip Replacement

Objective This study was aimed to observe the efficacy and safety of combined intravenous(IV)and topical application of tranexamic acid(TXA)in primary unilateral THA(total hip arthroplasty,THA)compared with the IV-TXA and the topical-TXA.Methods Select our hospital 110 patients with primary unilateral THA from January 2015 to March 2016,the patients were randomly divided into simple intravenous application TXA group(group A,n = 40),topically application TXA group(group B,n = 40)and the combined use of TXA group(group C,n = 30).Group A gives the total of 15 mg/kg TXA 10 min before the skin incision,and clip drainage tube 2 hours postoperation;Group B gives the total of 1.5 g TXA after closed the incision through the drainage tube retrograde injection and clip drainage tube 2 hours postoperation;Group C gives the combined use of Group A and B.Observe and record three groups of operation time,perioperative blood loss,perioperative blood transfusion,seroma volume of drainage 24 h after surgery and postoperative drain Hb drop in maximum.The fifth day evaluate the three groups of pain use VAS pain score evaluation after THA,postoperative 1 month of THA also evaluate the three groups the joint function recovery use Harris score evaluation.Observe three groups of the deep vein thrombosis(DVT)of lower limbs and symptomatic pulmonary bolt(PE)3 months after THA.Results Compared 3 groups of the operation time,P > 0.05,there was no statistical significance differences.A,B,C groups total perioperative blood loss,were respectively(886.20 ± 35.58),(971.87 ± 68.55),(773.89 ± 58.60)m L,two comparison between groups,P < 0.05;Perioperative blood transfusion rate was respectively 12.50%(5/40),17.50%(7/40),6.67%(2/30);Group C in Hb maximum falling was below A,B group,P < 0.05;seroma volume of drainage 24 h after surgery respectively(223.68 + 26.46),(198.41-15.42),(175.84-17.94)m L,two comparison between groups,P < 0.05).group A of The fifth day VAS score higher than that of group B,C,P < 0.05.there was no statistical significance differences of Three groups in the total hospitalization days,in Harris scoring.Group C occurred 1 case of popliteal vein thrombosis of lower limb in the postoperative hospitalization,Group A had a case of a calf muscle,Group B did not have a blood clot,there was no statistically significant difference(P = 1).Conclusion Combined use of TXA can reduce the total perioperative blood loss,postoperative flow,and does not increase the risk of thrombotic events,the effect is better than that of IV-TXA,topical-TXA.