Song Eun-Kyoo, Seon Jong-Keun, Prakash Jatin, Seol Young-Jun, Park Yong Jin, Jin Cheng
Department of Orthopaedic Surgery, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea.
Department of Orthopaedic Surgery, Chonnam National University Hospital, Gwangju, South Korea.
J Arthroplasty. 2017 Jan;32(1):37-42. doi: 10.1016/j.arth.2016.06.052. Epub 2016 Jul 6.
In this study, we tried to assess if combined method (intravenous [IV] and topical) of tranexamic acid (TXA) administration, which has been shown to be superior in conventional arthroplasty, has similar effect in navigational arthroplasty compared to administration of drug either individually.
In present randomized control trial, 200 patients were randomly divided in one of the 4 groups using computer-generated tables-control, IV, intraarticular, and combined. We studied evident loss through drain, total loss based on Gross method and hemoglobin balance method, hidden losses, hemoglobin and hematocrit drop, functional scores, and all possible complications related to TXA.
Evident loss in combined group was 535.55 mL, not significantly less than IV (585 mL, P = .15) and intraarticular group (514 mL, P = .74). However, these were significantly less than control group (696 mL, P = .000). Functional scores and recovery rates were, however, comparable in all 4 groups. No patients in any group developed symptomatic deep vein thrombosis.
Tranexamic use decreases blood loss in navigation-assisted arthroplasty, however, less than that observed for conventional arthroplasty in literature. Further, combined group has no added advantage over other methods of drug administration. We believe that additional amount of TXA administered in combined regimen may not be clinically useful. Further TXA group did not have any advantage in terms of functional recovery over control group.
在本研究中，我们试图评估已证实在传统关节置换术中更具优势的氨甲环酸（TXA）联合给药方法（静脉注射[IV]和局部给药）与单独给药相比在导航关节置换术中是否具有相似效果。
在当前的随机对照试验中，使用计算机生成的表格将200例患者随机分为4组之一——对照组、静脉注射组、关节内注射组和联合给药组。我们研究了引流管的明显失血、基于格罗斯方法和血红蛋白平衡法的总失血量、隐性失血、血红蛋白和血细胞比容下降、功能评分以及与TXA相关的所有可能并发症。
联合给药组的明显失血量为535.55 mL，显著少于对照组（696 mL，P = .000），但与静脉注射组（585 mL，P = .15）和关节内注射组（514 mL，P = .74）相比差异不显著。然而，所有4组的功能评分和恢复率相当。任何组均无患者发生有症状的深静脉血栓形成。
在导航辅助关节置换术中使用氨甲环酸可减少失血，然而，少于文献中传统关节置换术的失血量。此外，联合给药组与其他给药方法相比并无额外优势。我们认为联合给药方案中额外剂量的TXA可能并无临床益处。此外，TXA组在功能恢复方面并不优于对照组。
