Case Analysis Of Short-term Use Of Tourniquet Combined With Tranexamic Acid For Total Knee Arthroplasty

Background: China is gradually entering an aging society,and patients with knee osteoarthritis(KOA)will gradually increase.The incidence rate of the elderly over 60 years old is 50%,the incidence rate of the elderly over 75 years old is as high as 80%,and the disability rate is as high as 55% or more.Although total knee arthroplasty(TKA)can completely cure a variety of knee-related diseases and symptoms,but the surgery has more soft tissue around the knee joint,the surgical wound is larger,and the patient has excessive blood loss during the perioperative period.The use of tourniquet and tranexamic acid is a commonly used method to reduce blood loss in artificial total knee arthroplasty.The most common hemostasis program is the operation of the frontal tourniquet before surgery,and the entire surgical procedure is continued.An intravenous injection of tranexmic acid(TXA)was started.However,if the tourniquet is used for a long time,the tissue is prone to reperfusion injury.It is easy to cause fibrinolysis,which leads to a large amount of blood loss in postoperative patients,which is not conducive to postoperative rehabilitation.This study investigated whether the use of a temporary tourniquet combined with tranexamic acid for total knee arthroplasty could improve the drawbacks of these conventional surgical procedures.Objective: To analyze the cases of short-term use of tourniquet combined with tranexamic gauze hemostasis in knee replacement surgery in our hospital,to introduce a time to significantly shorten the tourniquet use time and reduce postoperative recessive blood loss and perioperative blood loss The method of hemostasis is to carry out preliminary experiments for further multi-center,multi-blind,randomized controlled trials.Methods: TKA 1.0 g was instilled 30 min before TKA,and the median incision was made in the knee.The medial approach was used.The tourniquet was used only when the prosthesis was installed.After the prosthesis was installed,the tourbone was solidified and the tourniquet was released.The tranexamic acid gauze was used to fill and press the hemostasis,and the tranexamic acid gauze was stuffed in the soft tissue space and the soft tissue and the prosthesis gap.Results: The hemoglobin contents on day 1,day 2 and day 3 were 121.00 g/L,113.00 g/L and 108.00 g/L,respectively(preoperative hemoglobin content: 135.00 g/L).On the first,second and third day after surgery,hematocrit was 0.368 L/L,0.348 L/L and 0.333 L/L,respectively(preoperative hematocrit: 0.421 L/L).Intraoperative tourniquet use time is about 12.00 min.The left thigh was slightly swollen after surgery,and was 41.90 cm,43.10 cm,and 43.00 cm on the 1st,2nd,and 3rd day after surgery(the left thigh circumference was about 40.80 cm before surgery).The patient's blood volume is about 3.660 L,the total blood loss is about 322.08 ml,the total dominant blood loss is about 180.37 ml(the drainage volume is about 45.00 ml,the intraoperative dominant blood loss is about 135.37 ml),and the hidden blood loss is about It is 141.71 ml.The blood drainage volume of the left knee was 20.00 ml 6 hours after the operation,and the blood drainage volume of the left knee was 45.00 ml 18 hours after the operation.Review of the lower extremity ultrasound showed no venous thrombosis.At the first month and the third month after the operation,the function of the left knee joint recovered well,and the ultrasound of both lower extremities showed no venous thrombosis.Conclusion: In TKA,the patient took a short-term hemostasis with tranexamic acid to significantly reduce the time to use the tourniquet during TKA,although it will slightly increase the amount of intraoperative dominant blood loss,but because it can reduce More postoperative recessive blood loss,in general,can reduce the total perioperative blood loss of the patient.The patient repeatedly reviewed the lower extremity venous ultrasound and found no venous thrombosis of the lower extremity,which was safe.The hemostasis program is worthwhile to continue the large-scale randomized controlled trials,resulting in a more powerful basis for reducing blood loss and better guiding clinical work.