| Objective:To study the effect of topical low dose tranexamic acid(TXA)on postoperative blood loss in patients who undergoing primary total knee arthroplasty(TKA).Methods:First-time total knee arthroplasty for knee osteoarthritis(KOA)in patients and orthopedic inpatients at the fifth affiliated hospital of Kunming Medical University from September 2015 to September 2017 The patients were randomized into experimental group and matched group.The method and content of all patients were informed.After the patient fully understood the risks and expected benefits,the patients voluntarily chosed and agreed to sign.Informed consent.The subjects were equally divided into experimental group and matched group by using a random number table:30 patients in the experimental group diluted 0.5 g of tranexamic acid in 50 ml of normal saline before closing the wound with a 50 ml syringe to inject locally into the soft tissues around the knee surgery incision.In the control group,30 patients were given an equal volume of normal saline before closing the wound with a 50 ml syringe and locally injected into the soft tissue around the knee surgical incision(control group).To record and monitor bleeding-related indexes during perioperative period in the experimental group and matched group of patients:intraoperative blood loss,drainage within 24 hours after surgery,hidden blood loss within 24 hours after surgery,blood transfusion within 24 hours after surgery,and blood transfusion rate within 24 hours after surgery.D-The numerical changes of dimer at 1 day,3 days,7 days,and 14 days after operation,knee joint activity,and KSS function score at 3 days,7 days,2 weeks,January,March,and June after surgery Change in value.Within 2 weeks after operation,patients were closely observed whether there were clinical symptoms associated with deep venous thrombosis such as pain or swelling in both lower extremities.Combined with coagulation function monitoring,patients with high suspicion of deep venous thrombosis of both lower extremities were required to perform double-limb vascular procedures in time.Ultrasound examination.Statistical analysis of measurement data using independent sample T test to compare the differences between groups,observe the difference by counting data statistical analysis with using X2 test,the results suggesting that P<0.05 was statistically significant.Results:The intraoperative blood loss in the tranexamic acid group and the control group was(340.00 ± 193.40)ml and(343.33 ± 215.65)ml,respectively,and there was no obviously difference(P>0.05).The drainage volume was(319.00 ±85.71)ml and(528.33 ± 88.59)ml at 24 hours after operation in both groups,which was statistically significant(P<0.05).The amount of latent blood loss 24 hours after operation was(333.62± 115.53)ml and(594.65 ±87.41)ml,respectively.The results showed that the amount of hidden blood loss in the tranexamic acid group was obviously lower than that in the matched group,and there were obviously differences between the experimental group and matched group.(P<0.05).The postoperative tranexamic acid group transfusion rate was 16.7%and the control group was 36.7%.There are significant differences between the experimental group and matched group(P<0.05).The average blood transfusion volume in both groups was(320.00±83.67)ml and(583.33 ± 133.71)ml,respectively,and there are significant differences between the experimental group and matched group(P<0.05).The D-dimer in the experimental group and matched group was(6.66 ±0.70)and(6.46 ±0.70),three days(6.98 ± 0.53)and(6.74 ± 0.44),and seven days(5.50 ± 0.86)and(5.58 ± 0.85)14.Days(3.52 ± 0.69)and(3.37 ± 0.65),there was no obviously difference between the experimental group and matched group(P>0.05).No thrombotic events occurred in the experimental group and the control group(P>0.05).Patients were followed up for 6 months.The degree of knee joint motion in both groups was 3 days(41.93 ± 7.07 °)and(34.03 ± 6.97 °),7 days(61.1 ± 6.73 °)and(52.53 ±9.48°),and 1month(91.67±7.90°)and(83.27±8.19°),there are significant differences between the experimental group and matched group(P<0.05),there was no statistically significant difference(102.03 ±4.9°)and(104.07 ±4.39°)at 3 months(P>0.05),and 6 months(106.37 ± 3.62°)and(107.73 ± 3.05°)There was no significant difference between the experimental group and matched group(P>0.05).The postoperative KSS function scores of the experimental group and matched group were 3 days after operation(30.87 ± 4.18)and(28.07 ± 2.73)and 7 days(55.93±3.76)and(49.83±5.17);1 month(72.30±7.75)and(59.87±6.37)were statistically significant(P<0.05),and 3 months(92.37 ± 3.76)and(91.87 ±4.36)were 6 months(95.17).There was no significant difference in the function scores of(95.17± 2.64)and(95.30 ± 3.14)KSS between the experimental group and matched group(P>0.05).Conclusion:To those patients with unilateral total knee arthroplasty for the first time,injecting 0.5g tranexamic acid diluted in 50ml physiological saline into the soft tissues around the knee incision with a 50ml syringe before closing the wound can obviously reduce the post operative drainage volume,post operative recessive blood loss,blood transfusion volume and blood transfusion ratio,and short the knee joint function recovery time without increasing the risk of complications such as the formation of deep vein thrombosis.Consequently,for those patients with unilateral total knee replacement for the first time,topical low-dose tranexamic acid is effective and safe.In addition,it is a facilitation for the recovery of knee joint after early operation. |
PDF Full Text Request