Steinhaus Michael E, Buksbaum Joshua, Eisenman Avraham, Kohli Monal, Fragomen Austin T, Rozbruch S Robert
Limb Lengthening and Complex Reconstruction Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
J Knee Surg. 2020 May;33(5):440-444. doi: 10.1055/s-0039-1678540. Epub 2019 Feb 12.
Blood loss remains a significant source of morbidity and mortality in orthopaedic surgery, with transfusions associated with an increased risk of infection, length of stay, delayed rehabilitation, and significantly increased hospitalization costs. The purpose of this study was to assess whether the use of tranexamic acid (TXA) is effective in reducing postoperative blood loss in patients undergoing distal femoral osteotomy (DFO). A retrospective review was performed of all patients undergoing DFO by a single surgeon from 2010 to 2017, with a change in protocol occurring in 2014, after which all patients received TXA. Patients in the TXA group ( = 24) received 1-g TXA immediately prior to incision followed by a second dose of 1-g TXA 4 hours after the administration of the first dose. Patients in the control group ( = 28) did not receive TXA. Drainage was recorded through a subfascial drain that remained for 24 hours postoperatively. Postoperative hemoglobin, hematocrit, and transfusions, as well as demographic factors, including age, gender, body mass index (BMI), medical comorbidities, and ASA (American Society of Anesthesiologists) class, were recorded. Multivariate regression analysis adjusting for potential confounding variables was performed. With the exception of gender, the two groups did not differ significantly in baseline characteristics, including age, BMI, and ASA class. There was a significant difference in postoperative blood loss, with those receiving TXA having a mean drain output of 184.2 versus 242.1 mL for the control group ( = 0.02), which persisted after regression analysis ( < 0.005). Blood loss differed between patients who received one (250 mL) dose and those who received two (162.2 mL) doses of TXA, although this difference was insignificant ( = 0.489). There were no differences in postoperative hemoglobin and hematocrit levels. One patient (control group) required blood transfusion postoperatively. There were no complications related to TXA. In conclusion, TXA results in less postoperative blood loss in DFO, with the most pronounced effect in those who receive two doses. Future research should involve a larger, prospective study to assess for differences in postoperative hemoglobin/hematocrit levels and transfusion rates.
在骨科手术中，失血仍然是发病和死亡的一个重要原因，输血会增加感染风险、延长住院时间、延缓康复，并显著增加住院费用。本研究的目的是评估使用氨甲环酸（TXA）是否能有效减少接受股骨远端截骨术（DFO）患者的术后失血。对2010年至2017年由同一位外科医生进行DFO手术的所有患者进行了回顾性研究，2014年手术方案发生了变化，此后所有患者均接受TXA治疗。TXA组（n = 24）的患者在切口前立即接受1 g TXA，在首次给药4小时后再给予第二剂1 g TXA。对照组（n = 28）的患者未接受TXA治疗。通过术后留置24小时的筋膜下引流管记录引流量。记录术后血红蛋白、血细胞比容和输血情况，以及包括年龄、性别、体重指数（BMI）、合并症和美国麻醉医师协会（ASA）分级在内的人口统计学因素。进行了调整潜在混杂变量的多变量回归分析。除性别外，两组在年龄、BMI和ASA分级等基线特征方面无显著差异。术后失血量有显著差异，接受TXA治疗的患者平均引流量为184.2 mL，而对照组为242.1 mL（P = 0.02），回归分析后该差异仍然存在（P < 0.005）。接受一剂（250 mL）TXA和两剂（162.2 mL）TXA的患者失血量有所不同，尽管这种差异不显著（P = 0.489）。术后血红蛋白和血细胞比容水平无差异。一名患者（对照组）术后需要输血。未发生与TXA相关的并发症。总之，TXA可减少DFO术后的失血量，对接受两剂TXA的患者效果最为显著。未来的研究应包括规模更大的前瞻性研究，以评估术后血红蛋白/血细胞比容水平和输血率的差异。
