Department of Orthopedics, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Adv Ther. 2021 May;38(5):2542-2557. doi: 10.1007/s12325-021-01719-5. Epub 2021 Apr 8.
Traditional fully cemented prosthesis for total knee arthroplasty (TKA) has many disadvantages. Current studies have shown that the effects of mixed fixation TKA are the same as or even better than those of fully cemented TKA. We aimed to compare the total blood loss (TBL) in the two fixation types of TKA and the hemostatic effects of different doses of tranexamic acid (TXA) for reverse hybrid TKA.
From September 2018 to November 2020, 233 patients with knee osteoarthritis undergoing unilateral TKA were randomly divided into four groups: groups 1 and 2: fully cemented TKA + intra-articular injection (IAI) of either 1 g TXA (n = 54) or 2 g TXA (n = 60); groups 3 and 4: reverse hybrid TKA + IAI of either 1 g TXA (n = 56) or 2 g TXA (n = 63). All patients were administered intravenous drip of TXA (20 mg/kg) as the basic drug. Perioperative and follow-up data of all patients were compared.
The TBL in groups 1, 2, and 3 was higher than that in group 4 (P < 0.0001). The TBL in group 1 was significantly less than that in group 3 (P < 0.05). Although there was no significant difference in blood transfusion demand among the four groups (P > 0.05), the number of anemic patients who did not meet the standard of blood transfusion in group 4 decreased significantly (P < 0.0001). There was no significant difference in pain, function or thrombotic complications among all patients.
The TBL in reverse hybrid TKA is larger than in fully cemented TKA. For reverse hybrid TKA, the hemostatic effect of TXA with 2 g of IAI was significantly better than with 1 g. Although this method does not reduce the need for blood transfusion, it can significantly reduce the incidence of postoperative anemia.
传统的全水泥固定假体用于全膝关节置换术（TKA）有许多缺点。目前的研究表明，混合固定 TKA 的效果与全水泥 TKA 相同，甚至更好。我们旨在比较两种 TKA 固定类型的总失血量（TBL）和不同剂量氨甲环酸（TXA）对反向混合 TKA 的止血效果。
2018 年 9 月至 2020 年 11 月，233 例单侧 TKA 膝关节骨关节炎患者随机分为四组：组 1 和 2：全水泥 TKA+关节内注射（IAI）分别为 1g TXA（n=54）或 2g TXA（n=60）；组 3 和 4：反向混合 TKA+IAI 分别为 1g TXA（n=56）或 2g TXA（n=63）。所有患者均给予静脉滴注 TXA（20mg/kg）作为基础药物。比较所有患者的围手术期和随访数据。
组 1、2 和 3 的 TBL 均高于组 4（P<0.0001）。组 1 的 TBL 明显少于组 3（P<0.05）。虽然四组间输血需求无显著差异（P>0.05），但组 4 中未达到输血标准的贫血患者数量明显减少（P<0.0001）。所有患者的疼痛、功能或血栓并发症均无显著差异。
反向混合 TKA 的 TBL 大于全水泥 TKA。对于反向混合 TKA，IAI 用 2g TXA 的止血效果明显优于 1g。虽然这种方法不能减少输血的需求，但可以显著降低术后贫血的发生率。
