Moo Ing H, Chen Jerry Y Q, Pagkaliwaga Eric H, Tan See W, Poon Kein B
Department of Orthopaedics Surgery, Changi General Hospital, Singapore.
J Arthroplasty. 2017 May;32(5):1483-1487. doi: 10.1016/j.arth.2016.12.028. Epub 2016 Dec 24.
Total knee arthroplasty (TKA) is associated with major blood loss and blood transfusion is often required. This study aimed to evaluate the efficacy of bone wax in reducing blood loss and transfusion rates after TKA.
A prospective randomized controlled study that included 100 patients undergoing primary unilateral TKA with cement was conducted in a tertiary center between March 2014 and June 2014. The bone wax group received 2.5 g of bone wax, applied onto the uncovered bone around the prostheses and the nail holes before the tourniquet was released, whereas the control group had hemostasis achieved using electrocautery only. Total blood loss was calculated using the hemoglobin balance method.
There were no demographic differences between the 2 groups. The preoperative serum hemoglobin levels were comparable between the 2 groups. The drop in serum hemoglobin levels at 24 h post-TKA was 1.6 ± 0.9 and 2.1 ± 1.1 g/dL in the bone wax and control groups respectively (P = .021), while the drop in serum hemoglobin levels at 72 h post-TKA was 2.7 ± 1.1 and 3.6 ± 1.2 g/dL respectively (P = .013). Total blood loss at 72 h post-TKA was 987.9 and 1183.5 mL for the bone wax and control groups respectively (P = .017). There was no adverse event associated with the use of bone wax at the 3-month follow-up.
The application of bone wax in TKA was safe and effective for reducing total blood loss and maintaining higher hemoglobin levels.
全膝关节置换术（TKA）常伴有大量失血，通常需要输血。本研究旨在评估骨蜡在减少TKA术后失血及输血率方面的疗效。
2014年3月至2014年6月在一家三级中心进行了一项前瞻性随机对照研究，纳入100例行初次单侧骨水泥型TKA的患者。骨蜡组在松开止血带前，将2.5 g骨蜡涂抹于假体周围及钉孔处暴露的骨面上，而对照组仅使用电灼止血。采用血红蛋白平衡法计算总失血量。
两组患者的人口统计学特征无差异。两组术前血清血红蛋白水平相当。TKA术后24小时，骨蜡组和对照组血清血红蛋白水平下降分别为1.6±0.9和2.1±1.1 g/dL（P = 0.021），而TKA术后72小时血清血红蛋白水平下降分别为2.7±1.1和3.6±1.2 g/dL（P = 0.013）。TKA术后72小时，骨蜡组和对照组的总失血量分别为987.9和1183.5 mL（P = 0.017）。在3个月的随访中，未发现与使用骨蜡相关的不良事件。
在TKA中应用骨蜡对于减少总失血量和维持较高的血红蛋白水平是安全有效的。
