Department of Orthopedic Surgery, West China Hospital, West China Medical School, SiChuan University, 37# Wainan GuoXue Road, ChengDu, SiChuan Province, People's Republic of China.
Department of Radiology, West China Hospital, West China Medical School, SiChuan University, ChengDu, SiChuan Province, People's Republic of China.
BMC Musculoskelet Disord. 2019 Sep 4;20(1):402. doi: 10.1186/s12891-019-2767-x.
The lower limb joints, including hip and knee, are the most commonly involved joints in haemophilic arthropathy. With a higher risk of transfusion, total hip and knee arthroplasty (THA and TKA) are still the first choice after failure of conservative treatment. In the present study, we aimed to analyze clinical outcomes and complications rate after total joint arthroplasty of the lower limbs using tranexamic acid (TXA) or not.
Thirty-four patients with haemophilia A undergoing 24 TKA and 18 THA were evaluated in this retrospective study (No. 201302009). Based on using TXA or not, they were divided into either TXA (12 knees and 10 hips) or Non-TXA groups (12 knees and 8 hips). Total blood loss, intraoperative blood loss, total amount of FVIII usage, range of motion, inflammatory biomarkers, joint function, pain status, complication rate and patient satisfaction were assessed and compared at a mean follow-up of 68 months.
Usage of TXA can decrease not only the perioperative blood loss (p = 0.001), transfusion rate (p = 0.017) and supplemental amount of FVIII (p < 0.001) but also swelling ratio, surgical joint pain. Moreover, compared with non-TXA group, the patients in TXA group had a lower level of inflammatory biomarkers and better joint function.
The hemophiliacs treated with TXA had less perioperative blood loss, hidden blood loss, transfusion rate, a lower ratio of postoperative knee swelling, less postoperative joint pain, lower levels of inflammatory biomarkers and better joint function. Further studies need performing to assess the long-term effects of TXA in these patients.
下肢关节（包括髋关节和膝关节）是血友病性关节病中最常受累的关节。由于需要更高的输血风险，全髋关节和膝关节置换术（THA 和 TKA）仍然是保守治疗失败后的首选治疗方法。在本研究中，我们旨在分析使用或不使用氨甲环酸（TXA）进行下肢关节全关节置换术后的临床结果和并发症发生率。
在这项回顾性研究中，评估了 34 名接受 24 例 TKA 和 18 例 THA 的血友病 A 患者（编号 201302009）。根据是否使用 TXA，他们被分为 TXA 组（12 个膝关节和 10 个髋关节）或非-TXA 组（12 个膝关节和 8 个髋关节）。在平均 68 个月的随访中，评估并比较了总失血量、术中失血量、FVIII 使用总量、关节活动度、炎症生物标志物、关节功能、疼痛状况、并发症发生率和患者满意度。
使用 TXA 不仅可以减少围手术期失血（p=0.001）、输血率（p=0.017）和补充 FVIII 的量（p<0.001），还可以减少肿胀比率和手术关节疼痛。此外，与非-TXA 组相比，TXA 组患者的炎症生物标志物水平更低，关节功能更好。
接受 TXA 治疗的血友病患者围手术期失血、隐性失血、输血率、术后膝关节肿胀比例、术后关节疼痛、炎症生物标志物水平和关节功能均较低。需要进一步研究来评估 TXA 在这些患者中的长期效果。
