Study On The Mode Of Administration In Total Hip Arthroplasty Of The Efficacy And Safety Of Different Tranexamic Acid

Background: Currently,Total Hip Arthroplasty(THA)has been recognized as the most effective treatment for all kinds of hip diseases and severe hip fractures.The perioperative blood loss of THA has been plagued by clinicians;tranexamic acid(Tranexamic Acid,TXA THA)can effectively reduce perioperative blood loss.However,the way of drug delivery and the safety of the drug are still controversial.Objective: A retrospective analysis was made of 148 cases of unilateral THA in our hospital for the first time from September 2015 to September 2017 due to the fracture of the neck of the femur(GardenIII,IV).Among them,72 were male and 76 were female.The age is between the age of 55 years and-78 years,with the average age of 70.95 + 5.53 years.The local medication group: 45 cases,including 22 males and 23 females,with an average age of 70.33 + 5.67 years.Delivery method: after fascia suture,1g tranexamic acid diluted in 20 ml saline,through the syringe into the joint cavity,and clamping of the drainage tube for 4 hours.Intravenous drug group: a total of 57 cases,including 28 males and 29 females,with an average age of 71.93 + 5.58 years.Delivery method: 15 minutes before skin incision with 1g tranexamic acid diluted in 100 ml saline intravenously.Intravenous combined with local medication group: a total of 46 cases,including 22 males and 24 females,with an average age of 70.78 + 5.30 years.The way of administration: the combination of the two methods of administration.Results: the combined group was compared with the other two groups:in the postoperative drainage volume,the combined group(181.6 + 30.62)was lower than that in the intravenous drip group,241.4 + 29.91,and the local group(246.62 + 33.17),the difference was statistically significant(P< 0.05).In terms of total blood loss after operation,the total blood loss in the combined group(652.4 + 212.3)was lower than that in the intravenous drip group(867.9 + 296.8)and the local group(894.7 + 363.6),the difference was statistically significant(P < 0.05).In terms of transfusion rate,the blood transfusion rate in the combined group was 4.35%(2/46),which was lower than that in the intravenous drip group 14.03%(8/57)and the local group 15.56%(7/45),the difference was statistically significant(P< 0.05).The incidence rate of pulmonary embolism and deep vein thrombosis occurred in the combined group,(1/46)and intravenous group(2/57)local level group(1/45)and there was no significant difference in difference(P > 0.05),three groups of patients in the perioperative period ofwound infection,hip dislocation,subcutaneous ecchymosis around the wound and the incidence of adverse events between there was no significant difference(P > 0.05).There was no significant difference in total blood loss,postoperative drainage volume and blood transfusion rate between the pure intravenous drug group and the local medication group(P > 0.05).Conclusion: intravenous combined with local application of TXA group can reduce total blood loss,postoperative blood transfusion rate and postoperative drainage volume compared with simple vein or local application of TXA.At the same time,the combined use of drugs does not increase the risk of complications such as deep venous thrombosis and pulmonary embolism.