Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China.
Arch Orthop Trauma Surg. 2021 Sep;141(9):1463-1472. doi: 10.1007/s00402-020-03558-5. Epub 2020 Jul 26.
The purpose of this study was to investigate whether TXA can effectively reduce blood loss after HTO and related complications and to evaluate its safety.
From March 2016 to March 2018, 100 patients who underwent medial opening wedge HTO in the Department of Orthopedics, the second affiliated hospital of xi'an jiaotong university, with an average age of 52.8 ± 3.2 years, were randomly divided into the TXA group (using intravenous TXA) and the control group (using the same amount of normal saline), with 50 patients in each group. The postoperative wound drainage volume, decrease in hemoglobin and hematocrit value, total blood loss, wound healing, blood transfusion, deep venous thrombosis (DVT) and pulmonary embolism (PE) were compared between the two groups.
The drainage volume on the first postoperative day and the total drainage volume of the TXA group were significantly lower compared with those of the control group (145.7 vs 264.5 ml, 282.3 vs 413.2 ml, P < 0.05). The decreases in the hemoglobin and hematocrit values on the postoperative first, second and fifth days were lower in the TXA group than those in the control group (1.4 VS 3.5, 2.6 vs 3.3, 1.9 vs 2.9 g, P < 0.05; 3.3 vs 5.5, 5.0 vs 9.1, 3.8 vs 7.2%, P < 0.05), and the mean total blood loss was also lower in the TXA group than that in the control group (477.9 vs 834.6 ml, P < 0.05). In the control group, 1 patient had wound hematoma requiring additional paracentesis and pressure dressing, 1 patient had superficial wound infection requiring additional debridement, and 1 patient had postoperative blood transfusion compared to none in the TXA group (P > 0.05). There was no symptomatic DVT or PE in either of the groups.
Intravenous TXA can effectively and safely reduce blood loss and bleeding-related complications after HTO and was beneficial for the blood management of HTO.
本研究旨在探讨 TXA 是否能有效减少 HTO 后的出血量及相关并发症，并评估其安全性。
自 2016 年 3 月至 2018 年 3 月，西安交通大学第二附属医院骨科共收治 100 例接受内侧开放楔形 HTO 的患者，平均年龄 52.8±3.2 岁，采用随机数字表法将患者分为 TXA 组（静脉注射 TXA）和对照组（静脉注射等容量生理盐水），每组 50 例。比较两组患者术后伤口引流量、血红蛋白和红细胞压积值下降量、总失血量、伤口愈合情况、输血情况、深静脉血栓（DVT）和肺栓塞（PE）发生情况。
TXA 组术后第 1 天和第 1 天的引流总量明显低于对照组（145.7 vs 264.5 ml，282.3 vs 413.2 ml，P<0.05）。TXA 组术后第 1、2、5 天的血红蛋白和红细胞压积值下降量均低于对照组（1.4 vs 3.5，2.6 vs 3.3，1.9 vs 2.9 g，P<0.05；3.3 vs 5.5，5.0 vs 9.1，3.8 vs 7.2%，P<0.05），总失血量也低于对照组（477.9 vs 834.6 ml，P<0.05）。对照组有 1 例患者出现伤口血肿，需行额外穿刺抽吸和加压包扎；1 例患者出现伤口浅表感染，需行额外清创；1 例患者术后输血，而 TXA 组均未发生上述情况（P>0.05）。两组均无症状性 DVT 或 PE。
静脉注射 TXA 能有效、安全地减少 HTO 后的出血量及出血相关并发症，有利于 HTO 的血液管理。
