| BackgroundTotal knee arthroplasty(TKA)is currently recognized as the most direct surgical method for the treatment of knee osteoarthritis in the middle and late stages.It is becoming more and more popular,but patients often lose a lot of blood during the perioperative period.However,tranexamic acid(TXA),a plasminogen inhibitor,can effectively reduce the incidence of anemia and blood transfusion.It has been widely used in primary TKA.TXA can be used in various ways,including intravenous administration,topical administration,oral administration and the above-mentioned two or three combined administration methods.Topical administration also included intra-articular injection and soft tissue multi-point infiltration injection.Previous studies on intra-articular injection of TXA were mostly carried out under the condition of the same volume of TXA solution but different dosage.However,the results of the studies are different,and the research on intra-articular injection of TXA solution of different volume has not been reported in domestic and foreign.ObjectiveThis article intends to study the effect of intra-articular injection of different volumes and doses of TXA solution on blood loss during TKA,and to provide a new feasible solution for the application of TXA in TKA.MethodsSelection of 120 patients who had undergone unilateral TKA in the orthopedics department of our hospital from February 2019 to January 2020.Using the envelope method,they were divided into four groups:A,B,C,and D,each with 30 people.All patients received intravenous injection of TXA(1g:100mL)combined with 50mL cocktail(ropivacaine 20 mg,morphine 5 mg,epinephrine 0.3 mg)multi-point infiltration injection before implantation of the prosthesis.Group A(n=30)injected 1g/20mL of TXA solution along the incision of joint capsule after the joint capsule was sutured;Group B(n=30)injected lg/50mL TXA solution along the incision of joint capsule after the joint capsule was sutured;group C(n=30)injected TXA solution lg/100mL along the incision of joint capsule after the joint capsule was sutured;group D(n=30)injected TXA solution 2g/100mL along the incision of joint capsule after the joint capsule was sutured.Comparison of postoperative drainage,total blood loss,hidden blood loss,maximum postoperative hemoglobin decline,postoperative blood transfusion rate and the volume of blood transfusion,postoperative erythrocyte sedimentation rate,C-reactive protein,D-dimer,fibrinogen,visual analogue scale of resting and activity at 3 hours after the operation before the drainage tube removed and 7 days after the operation and postoperative complications and adverse reactions.Results1.There was no statistically significant difference in preoperative baseline data and preoperative laboratory tests among the groups of patients(p>0.05).2.The four groups of patients had differences in postoperative drainage,total blood loss,hidden blood loss and maximum hemoglobin decline,and the difference between the groups was statistically significant(p<0.05).Further pairwise comparisons show that the drainage volume of group C and group D(127±96mL,81±90mL)is less than that of group B 185 ±107mL,the difference is statistically significant(p<0.05),group B is less than group A 243±125mL,the difference is statistically significant(p<0.05),there is no statistical difference in postoperative drainage volume between group C and group D(p>0.05);in terms of total blood loss,group C and group D(1036±329mL,965±243mL)are less than group B 1195±303mL,the difference is statistically significant(p<0.05),group B is less than A Group 1357±334mL,the difference was statistically significant(p<0.05).There was no significant difference in total blood loss between group C and D(p>0.05);in terms of hidden blood loss,group C and group D(909±251 mL,884±204mL)is less than group A 1111±365mL,the difference is statistically significant(p<0.05).The difference in hidden blood loss between group A and group B,group B and group C,group C and group D all has no statistical significance(p>0.05);in terms of the maximum hemoglobin decline,group C and D(20.3±8.38g/L,19.5±6.90g/L)is less than that of group B 25.5±6.16g/L,and the difference was statistically significant(p<0.05).Group B was less than 29.5±7.72g/L of group A,the difference was statistically significant(p<0.05),compared with group D,the difference in the maximum hemoglobin decline was no statistical significance(p>0.05).3.In terms of postoperative erythrocyte sedimentation rate and C-reactive protein,there was no statistically significant difference between groups A,B,C,and D on the 3rd,6th,and 9th day after surgery(p>0.05).4.There was no significant difference between the groups in terms of D-dimer and fibrinogen on the 3rd day after surgery(p>0.05).5.There was no statistically significant difference in visual analog scores of knee joints at rest and in motion between groups of patients,At 3 hours after operation(before the clamped drainage tube was opened),(p>0.05);There was no statistically significant difference in visual analogue scores when patients in each group at rest and during activity 7 days after surgery(p>0.05).6.There was no statistically significant difference in blood transfusion rate and blood transfusion volume between groups after operation(p>0.05).7.No serious complications such as deep vein thrombosis of lower limbs and postoperative infection occurred in all groups of patients,and the wounds all healed by first intention.Conclusion1.When the dose of TXA injected into the articular cavity is the same,the blood loss after TKA decreases with the increase of the volume(0-100mL)of TXA solution,and the hemostasis effect was the best when 100mL solution was applied.2.When the volume of TXA solution injected into the articular cavity is the same,1g and 2g TXA have the same hemostatic effect,and it is more economical and convenient to apply 1g TXA.3.It is recommended that the ratio of TXA solution should be lg/100mL for intra-articular injection of TKA,which not only has a good hemostasis effect but also does not increase the risk of postoperative complications such as pain,infection,deep venous thrombosis of lower extremities and poor wound healing. |
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