Hospital for Special Surgery, New York, New York, USA.
Bone Joint J. 2020 Sep;102-B(9):1151-1157. doi: 10.1302/0301-620X.102B9.BJJ-2019-1777.R1.
Tranexamic acid (TXA) has been shown to reduce blood loss and transfusion requirements in patients undergoing orthopaedic surgery. There remains a lack of prospective evidence for the use of TXA in patients undergoing periacetabular osteotomy (PAO). The purpose of this study was to determine if intravenous (IV) TXA is effective in reducing calculated blood loss and transfusions after PAO.
This was a single-centre prospective double-blind placebo-controlled randomized trial of 81 patients aged 12 to 45 years undergoing elective PAO by a single surgeon. The intervention group (n = 40) received two doses of IV TXA of a maximum 1 g in each dose; the control group (n = 41) received two doses of 50 ml 0.9% saline IV. The primary outcome was perioperative calculated blood loss. Secondary outcomes included allogenic transfusions and six-week postoperative complications.
There were no differences in demographics or intraoperative variables between study groups. The TXA group demonstrated lower mean calculated blood loss (1,265 ml, (SD 321) vs 1,515 ml, (SD 394); p = 0.002) and lower frequency of allogenic transfusion (10%/n = 4 vs 37%/n = 15; p = 0.008). Regression analyses associated TXA use with significant reductions in calculated blood loss (p < 0.001) and transfusion (p = 0.007) after adjusting for age, sex, body mass index, preoperative haemoglobin, cell-saver volume, intraoperative mean arterial blood pressure, and operating time. No patients suffered venous thromboembolic complications.
In this trial, IV TXA decreased postoperative calculated blood loss by 293 ml and reduced the frequency of allogenic transfusions by 73% (37% vs 10%) following PAO. TXA may be safe and effective for reducing blood loss in patients undergoing PAO. Cite this article: 2020;102-B(9):1151-1157.
氨甲环酸（TXA）已被证明可减少接受骨科手术的患者的失血和输血需求。在接受髋臼周围截骨术（PAO）的患者中，仍缺乏使用 TXA 的前瞻性证据。本研究旨在确定静脉内（IV）TXA 是否可有效减少 PAO 后的计算失血量和输血。
这是一项由一位外科医生进行的单中心前瞻性双盲安慰剂对照随机试验，纳入了 81 名 12 至 45 岁的择期接受 PAO 的患者。干预组（n=40）接受了两剂最大剂量为 1g 的 IVTXA；对照组（n=41）接受了两剂 50ml0.9%生理盐水 IV。主要结局是围手术期计算的失血量。次要结局包括异体输血和术后 6 周的并发症。
两组患者的人口统计学或术中变量无差异。TXA 组的平均计算失血量（1265ml，（SD321））低于对照组（1515ml，（SD394）；p=0.002），异体输血的频率也较低（10%/n=4 与 37%/n=15；p=0.008）。回归分析表明，在调整年龄、性别、体重指数、术前血红蛋白、细胞保存器体积、术中平均动脉血压和手术时间后，TXA 的使用与计算失血量（p<0.001）和输血（p=0.007）显著减少相关。没有患者发生静脉血栓栓塞并发症。
在本试验中，静脉内 TXA 可减少术后计算失血量 293ml，将异体输血的频率降低 73%（37%比 10%），PAO 术后。TXA 可能是安全有效的，可减少接受 PAO 的患者的失血。引用本文：2020;102-B（9）：1151-1157。
