Balasubramanian N, Natarajan G B, Prakasam S
Department of Orthopaedic Surgery, Saveetha Medical College & University, Chennai, India.
Malays Orthop J. 2016 Nov;10(3):7-11. doi: 10.5704/MOJ.1611.020.
The number of total knee arthroplasties (TKA) performed is around two million annually worldwide and this number is expected to increase fivefold by 2025. The most common indication is osteoarthritis of the knee. Blood loss is significant during the post-operative period and blood transfusion when necessary has its own drawbacks. The use of intravenous tranexamic acid has significantly reduced blood loss. We analysed 35 patients who underwent staged bilateral TKA between August 2013 and February 2016 and had administered intra-articular tranexamic acid for one knee and intravenous tranexamic acid for the other knee. The results were analysed based on post-operative blood loss, change in haemoglobin (Hb) level and haematocrit (PCV) and the need for blood transfusion. The average postoperative blood loss was 129.57 ml and 277.71 ml for intra articular group and intravenous group respectively. A control group (no drug or placebo group) with age matched patients (n= 21) was chosen from medical records. The average blood loss in the control group was 493.81 ml. The fall in Hb level and PCV was 0.72 gm/dl and 2.62 % (Intra-articular Group), 1.36 gm/dl and 4.34 % (Intravenous Group) and 2.62 gm/dl and 5.52 % (Control). The number of transfusions were two (Intra-articular Group), five (Intravenous Group) and nine (Control). We conclude that when compared with intravenous route, intra-articular administration has significantly reduced blood loss, Hb level and PCV fall and the rate of blood transfusion.
全球范围内，每年进行的全膝关节置换术（TKA）数量约为200万例，预计到2025年这一数字将增长至五倍。最常见的适应症是膝关节骨关节炎。术后失血量大，必要时输血也有其自身的缺点。静脉注射氨甲环酸的使用显著减少了失血量。我们分析了35例在2013年8月至2016年2月期间接受分期双侧TKA的患者，其中一侧膝关节给予关节内氨甲环酸，另一侧膝关节给予静脉注射氨甲环酸。根据术后失血量、血红蛋白（Hb）水平和血细胞比容（PCV）的变化以及输血需求对结果进行了分析。关节内注射组和静脉注射组的平均术后失血量分别为129.57 ml和277.71 ml。从病历中选取了年龄匹配的患者作为对照组（无药物或安慰剂组，n = 21）。对照组的平均失血量为493.81 ml。Hb水平和PCV的下降在关节内注射组为0.72 gm/dl和2.62%，静脉注射组为1.36 gm/dl和4.34%，对照组为2.62 gm/dl和5.52%。输血量在关节内注射组为2次，静脉注射组为5次，对照组为9次。我们得出结论，与静脉途径相比，关节内给药显著减少了失血量、Hb水平和PCV的下降以及输血率。
