Comadoll James L, Comadoll Shea, Hutchcraft Audrey, Krishnan Sangeeta, Farrell Kelly, Kreuwel Huub T C, Bechter Mark
RoMedical Care, Inc, Salisbury, North Carolina, USA
Orthopedics. 2012 Jun;35(6):e785-93. doi: 10.3928/01477447-20120525-14.
Bleeding after total knee arthroplasty increases the risk of pain, delayed rehabilitation, blood transfusion, and transfusion-associated complications. The authors compared pre- and postoperative decreases in hemoglobin as a surrogate for blood loss in consecutive patients treated at a single institution by the same surgeon (J.L.C.) using conventional hemostatic methods (electrocautery, suturing, or manual compression) or a gelatin and thrombin-based hemostatic matrix during total knee arthroplasty. Data were collected retrospectively by chart review. The population comprised 165 controls and 184 patients treated with hemostatic matrix. Median age was 66 years (range, 28-89 years); 66% were women. The arithmetic mean ± SD for the maximal postoperative decrease in hemoglobin was 3.18 ± 0.94 g/dL for controls and 2.19 ± 0.83 g/dL for the hemostatic matrix group. Least squares means estimates of the group difference (controls-hemostatic matrix) in the maximal decrease in hemoglobin was 0.96 g/dL (95% confidence interval, 0.77-1.14 mg/dL; P<.0001). Statistically significant covariate effects were observed for preoperative hemoglobin level (P<.0001) and body mass index (P=.0029). Transfusions were infrequent in both groups. The frequency of acceptable range of motion was high (control, 88%; hemostatic matrix, 84%). In both groups, overall mean tourniquet time was approximately 1 hour, and the most common length of stay was 3 to 5 days. No serious complications related to the hemostatic agent were observed. These data demonstrate that the use of a flowable hemostatic matrix results in less reduction in hemoglobin than the use of conventional hemostatic methods in patient undergoing total knee arthroplasty.
全膝关节置换术后出血会增加疼痛、康复延迟、输血及输血相关并发症的风险。作者比较了在同一机构由同一位外科医生（J.L.C.）采用传统止血方法（电灼、缝合或手动压迫）或使用基于明胶和凝血酶的止血基质进行全膝关节置换术的连续患者术前和术后血红蛋白下降情况，以此作为失血的替代指标。通过查阅病历回顾性收集数据。研究人群包括165名对照组患者和184名接受止血基质治疗的患者。中位年龄为66岁（范围28 - 89岁）；66%为女性。对照组术后血红蛋白最大下降值的算术平均值±标准差为3.18 ± 0.94 g/dL，止血基质组为2.19 ± 0.83 g/dL。血红蛋白最大下降值的组间差异（对照组 - 止血基质组）的最小二乘均值估计为0.96 g/dL（95%置信区间，0.77 - 1.14 mg/dL；P <.0001）。观察到术前血红蛋白水平（P <.0001）和体重指数（P =.0029）有统计学意义的协变量效应。两组输血情况均不常见。可接受活动范围的频率较高（对照组88%；止血基质组84%）。两组总体平均止血带使用时间约为1小时，最常见的住院时间为3至5天。未观察到与止血剂相关的严重并发症。这些数据表明，在接受全膝关节置换术的患者中，使用可流动止血基质导致的血红蛋白下降比使用传统止血方法更少。
