Orthopedic and Traumatology Clinic, S. Maria della Misericordia Hospital, Via G. Dottori, 06100, Perugia, Italy,
Knee Surg Sports Traumatol Arthrosc. 2014 Nov;22(11):2756-62. doi: 10.1007/s00167-013-2674-x. Epub 2013 Sep 29.
To compare the blood loss and the blood transfusion between a control group and a group of patients following either a local administration of tranexamic acid or a mechanical post-operative knee flexion, a controlled randomized study was performed.
Sixty patients affected by primary knee osteoarthritis and candidates to receive a primary unilateral total knee arthroplasty were enrolled in a prospective, randomized, controlled study. Exclusion criteria were the following: tranexamic acid allergy, the use of pharmacological anticoagulant therapy, previous knee surgery and renal failure. For each patient, the following parameters were investigated: the blood loss volume, the haemoglobin and haematocrit concentrations and the blood transfusion needs.
Compared to the control group, the administration of systemic tranexamic acid significantly reduces (p < 0.05) both the blood loss (average reduction 39.8%) and the blood transfusion needs (64%). Furthermore, the tranexamic acid group shows a significant reduction (p < 0.05) compared to the knee flexion group of the blood loss (average reduction 31.8%) and the transfusion needs (65%). However, even if the knee flexion technique slightly reduces the blood loss (average reduction 11.6%) compared to the control group, this difference is not statistically significant (n.s.). Moreover, this treatment did not reduce the transfusion needs compared to the control group (n.s.). Incidence of complications was not influenced by any of the treatments.
The use of tranexamic acid compared to knee flexion and to control group significantly reduces blood loss and transfusion needs, without wound complications or symptomatic deep vein thrombosis.
Prospective therapeutic study, Level I.
比较局部应用氨甲环酸与术后膝关节被动屈伸运动在控制出血量和输血量方面的差异，为此我们进行了一项随机对照研究。
60 例原发性膝关节骨关节炎患者，拟行单侧初次全膝关节置换术，前瞻性随机对照研究。排除标准为：氨甲环酸过敏、使用药物抗凝治疗、既往膝关节手术和肾功能衰竭。对每位患者的以下参数进行了调查：出血量、血红蛋白和血细胞比容浓度以及输血需求。
与对照组相比，全身应用氨甲环酸可显著减少（p<0.05）出血量（平均减少 39.8%）和输血需求（64%）。此外，与膝关节被动屈伸运动组相比，氨甲环酸组的出血量（平均减少 31.8%）和输血需求（65%）也显著减少（p<0.05）。然而，即使膝关节被动屈伸运动组与对照组相比出血量略有减少（平均减少 11.6%），但这种差异无统计学意义（n.s.）。此外，与对照组相比，这种治疗方法并未减少输血需求（n.s.）。并发症发生率不受任何治疗方法的影响。
与膝关节被动屈伸运动和对照组相比，氨甲环酸的应用可显著减少出血量和输血需求，同时不会增加伤口并发症或有症状的深静脉血栓形成的风险。
前瞻性治疗研究，I 级。
