Treatment And Curative Effect Analysis Of Intraarticular Tranexamic Acid Plus 4-h Drain Clamping After Total Knee Replacement

Objective: Comparison of intraarticular application 1g tranexamic acid plus 4-h drain clamping and no drainage in the perioperative blood loss,postoperative recovery and length of hospital stay after the initial unilateral total knee replacement.Materials and Methods: A retrospective analysis of 80 cases of unilateral initial total knee arthroplasty that met the inclusion criteria from July 2018 to October 2019 in the Department of Bone and Joint Surgery,First Hospital of Jilin University.All patients received 1 g of tranexamic acid intravenously 30 minutes before the skin incision.Among them,the observation group(n=40)was sprinkled with 1g tranexamic acid before the joint capsule was sutured,and a drainage tube clamped by a forceps was placed and the drainage forceps were opened 4 hours after the operation.The control group(n=40)was neither sprayed with tranexamic acid nor placed for drainage,and the wound is sutured directly.The evaluated parameters include changes in hemoglobin before and after surgery,perioperative blood loss,blood transfusion rate,early postoperative complications,hospitalization days,postoperative HSS score,and knee mobility.Results: In terms of blood loss indexes,the postoperative hemoglobin(Hb)of the observation group decreased by 29.93±11.92g/L,and the control group decreased by 25.38±10.82g/L.There was no statistically significant difference in Hb reduction between the two groups(P>0.05).The trend of postoperative Hb changes showed that both groups dropped significantly on the first day after surgery,and the observation group dropped even more.The perioperative blood loss in the observation group was 897.85±327.82 ml,which was significantly higher than that of the control group 725.89±304.52ml(P < 0.05).Among them,4 cases in the observation group underwent blood transfusion,while none in the control group received blood transfusion.The difference between the two groups was statistically significant(P<0.05).In terms of postoperative complications,the observation group had 3 cases of ecchymosis around the incision,2 cases of tension blisters,and 1 case of delayed incision healing;in the control group,4 cases of periincision ecchymosis and 6 cases of tension blisters.All incisions healed well.There were no deep vein thrombosis and infectious complications in the two groups,and there was no statistically significant difference between the two groups in complications(P>0.05).The average hospital stay of the observation group was 7.48±2.48 days,which was higher than that of the control group 6.45±1.32 days(P<0.05).The postoperative recovery,the joint range of motion and HSS at discharge,3 months after surgery,and 6 months after surgery There was no statistically significant difference between the two groups(P>0.05)Conclusion: First,clamping and drainage for 4 hours combined with the application of 1g tranexamic acid in the articular cavity is almost the same as not receiving drainage in terms of postoperative functional recovery and postoperative complications;secondly,compared with patients who do not receive drainage,postoperative blood loss is increased,and Eventually it turns into an increase in the need for blood transfusion;the final indwelling drainage will interfere with early postoperative mobilization and prolong hospital stay.In addition,the drained blood often causes a greater psychological burden for patients;for clinical medical staff,drainage tube care,extubation operations,and drainage port bleeding cause increased workload.Therefore,the use of drainage tubes can be completely avoided in the initial simple total knee arthroplasty.