Zhu Meng, Chen Jerry Yongqiang, Yew Andy Khye Soon, Chia Shi-Lu, Lo Ngai Nung, Yeo Seng Jin
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
J Orthop Surg (Hong Kong). 2015 Dec;23(3):290-3. doi: 10.1177/230949901502300305.
To compare the outcome after simultaneous bilateral total knee arthroplasty (TKA) with or without an intra-articular tranexamic acid (TXA) wash in terms of blood loss, haemoglobin change, and transfusion requirement.
35 women and 10 men (mean age, 67.5 years) who underwent primary simultaneous bilateral TKA by a single senior surgeon were compared with 45 matched controls. In the TXA group, 1500 mg of TXA diluted in 100 ml of 0.9% sodium chloride was administered as a wash after cementing of implant and before closure of the retinaculum. At least 5 minutes of contact time was allowed before wound closure and tourniquet deflation. No drain was used.
No patients had thromboembolic complication. Compared with controls, the TXA group had lower perioperative blood loss (920 vs. 657 ml, p=0.001), total blood loss (997 vs. 679 ml, p<0.001), blood transfusion rate (60% vs. 37.8%, p=0.035), percentage of patients requiring more than one blood unit (24.4% vs. 8.9%, p=0.048), and length of hospitalisation (6 vs. 4 days, p<0.001). Nonetheless, the 2 groups were comparable in blood units and volume transfused.
An intra-articular TXA wash during simultaneous bilateral TXA reduced total blood loss and resulted in a difference of 22.2% in blood transfusion rate and a 2-day reduction in the length of hospital stay.
比较同期双侧全膝关节置换术（TKA）中使用或不使用关节腔内氨甲环酸（TXA）冲洗在失血、血红蛋白变化及输血需求方面的结果。
将由一位资深外科医生进行初次同期双侧TKA的35名女性和10名男性（平均年龄67.5岁）与45名匹配的对照组进行比较。在TXA组中，在植入物固定后、滑膜缝合前，将1500毫克TXA稀释于100毫升0.9%氯化钠溶液中进行冲洗。在伤口缝合和止血带放气前允许至少5分钟的接触时间。未使用引流管。
无患者发生血栓栓塞并发症。与对照组相比，TXA组围手术期失血量更低（920 vs. 657毫升，p = 0.001）、总失血量更低（997 vs. 679毫升，p < 0.001）、输血率更低（60% vs. 37.8%，p = 0.035）、需要超过一个血单位的患者百分比更低（24.4% vs. 8.9%，p = 0.048）以及住院时间更短（6 vs. 4天，p < 0.001）。尽管如此，两组在输血单位和输血量方面具有可比性。
同期双侧TKA期间进行关节腔内TXA冲洗可减少总失血量，并使输血率相差22.2%，住院时间缩短2天。
