Analysis Of The Clinical Effect Of Topical Application Of Gauze With Tranexamic Acid In Total Knee Arthroplasty

Background:Knee joint osteoarthritis(osteoarthritis,OA)is a kind of articular cartilage degeneration and secondary bone hyperplasia of chronic joint disease characterized by,see more at in old people,women more than men,the disease will ultimately lead to joint deformity and loss of function.According to statistics,the incidence of knee osteoarthritis in people over 60 years old is 50%,and the incidence rate in people over 75 years old is 80%[1].Since total knee arthroplasty(TKA)has been applied in clinic,it has become the most common operation for patients with end-stage knee osteoarthritis.In the United States,it is estimated that 3.5 million patients will undergo total knee replacement by 2030,an increase of about 8 times in 2005 .As the quality of life,aging population and life expectancy increased,the number of patient undergoing total knee replacement surgery increased gradually.Total knee replacement because of intraoperatie cut bone cut bone and soft tissue release the cause of postoperative bleeding is more,studies show that unilateral TKA perioperative blood loss,500-2000 ml,because most of the elderly in patients undergoing total knee replacement,physiological function and compensatory ability is weak,postoperative anemia will for elderly patients with postoperative recovery and healing of incision,etc.Therefore,it is very important to control the amount of blood loss in patients with knee arthroplasty,and it is also the focus in recent years.Tranexamic acid(Tranexamic acid,TXA)is a kind of synthetic derivatives were lysine,its pharmacological mechanism is through with the fibrinolytic enzyme and fibrinolytic enzyme lysine binding sites on the original combination,inhibition of the fibrinolytic enzyme activation and the process of dissolving fibrin,reach the purpose of the control of postoperative blood loss .Studies have shown that the patients in TKA surgery after received tranexamic acid treatment,postoperative blood loss was significantly reduced,and some postoperative DVT(lower limb venous embolism),or PE(pulmonary embolism)was not increased risk .However,there is no uniform standard for the use,timing and optimal dosage of ammoniacal acid.Objective: through to the dalian municipal central hospital sports medicine line 60 patients with osteoarthritis of the first patients with unilateral total knee arthroplasty,from perioperatie blood loss and hemoglobin levels change,rate of blood transfusion,postoperative knee function score,etc.,research and discuss topical application of tranexamic acid on primary knee arthroplasty after blood loss and the effect to improve the function of knee joint function.Methods: selecting knee osteoarthritis first eligible for 60 patients with total knee arthroplasties,excluded patients with anemia,blood coagulation dysfunction,according to the intraoperative use of tranexamic acid,were randomly divided into experimental group and control group in the two groups.Experimental group(group A)using 2 g tranexamic acid soluble in 100 ml saline soak cotton gauze,in the surgery for bleeder compression hemostasis,and prosthesis after installation is complete,use gauze to cover joint surface for 5 minutes.The control group(group B)was used to soak gauze in100 ml normal saline and use the same method as group A.Observation of postoperative blood loss reduction,hemoglobin,blood transfusion cases(rate),postoperative limb swelling degree changes(patellar change week 10 cm diameter)and postoperative knee joint Hss score at 2 weeks and deep vein thrombosis,to carry out the analysis of the clinical efficacy and safety.Results: no statistical difference of two groups of patients admitted to hospital general data,in terms of the comparison of blood loss,postoperative total blood loss of group A(844.23 + 247.22)ml,postoperative total blood loss of group B(1077.09 + 327.93)ml,between the two groups was statistically significant(p < 0.05);In terms of the decrease of Hb after operation,the Hb level of group A in the first,3rd and 5th days after surgery was higher than that in group B,and the difference between the two groups was statistically significant(P < 0.05).In the comparison of the number of blood transfusion cases(rate): 1 case of blood transfusion in group A,blood transfusion rate 0.03,group B transfusion 5 cases,blood transfusion rate 0.17,P value =0.085,P value > 0.05,there was no statistical difference between the two groups.In the comparison of the changes of postoperative limb swelling,the two groups had lower limb circumference on day 1,day 3 and day 5,and the P value was less than 0.05,and there was a statistical difference between the two groups.In the postoperative Hss score,the P value of the Hss score of the two groups in group A and group B was < 0.05.Statistically significant.No incision infection,deep venous thrombosis,pulmonary embolism and other complications were found in both groups.conclusions:In primary unilateral total knee replacement,topical application of tranexamic acid gauze can significantly reduce the total blood loss,postoperative reduce postoperative limb swelling,and facilitate early postoperative patients(2 weeks)postoperative knee function recovery,and the risk of complications such as deep vein thrombosis,pulmonary embolism and incisional infection was not increased.