School of Clinical Medicine, Jining Medical University, Jining, People's Republic of China.
Department of Orthopedics, The People's Hospital of Zoucheng, The Affiliated Hospital of Jining Medical University, Jining, People's Republic of China.
Medicine (Baltimore). 2021 Aug 13;100(32):e26884. doi: 10.1097/MD.0000000000026884.
High tibial osteotomy (HTO) is a promising surgery that can treat osteoarthritis of the medial septum of the knee. However, the extensive release of soft tissue and the osteotomy gap may produce intraoperative and postoperative bone bleeding. Tranexamic acid (TXA) is an effective blood management strategy, as it competitively inhibits the activation process of plasminogen and prevents fibrinolytic enzymes from degrading fibrin. Therefore, we compared the operative bone bleeding of patients who underwent HTO who received either intravenous (IV) or topical TXA in this research.The medical records of a total of 191 patients (including 72 who received IV TXA, 64 who received topical TXA and 55 control patients) who received open-wedge HTO were retrospectively reviewed from January 2016 to August 2019. There were no obvious demographic differences between the groups. Here, we used independent parameters to assess the efficacy of topical and IV TXA in reducing blood loss.Compared with the IV TXA group, patients receiving topical TXA therapy had greater blood loss (622 ± 231 ml versus 451 ± 231 ml, mean difference 171 mL [95% CI, 87-254]; p < 0.001). The hemoglobin concentration of the IV TXA group was obviously higher than that of the topical medication group. No patients had thromboembolic complications during the entire study period.In our study, it seemed that either IV or topical use of TXA might reduce blood loss after open-wedge HTO, and the blood loss and amount of drainage in the IV TXA group showed huge decreases compared to those in the topical group.
胫骨高位截骨术（HTO）是一种有前途的手术，可以治疗膝关节内侧间室的骨关节炎。然而，广泛的软组织松解和截骨间隙可能会导致术中及术后骨出血。氨甲环酸（TXA）是一种有效的血液管理策略，因为它竞争性地抑制纤溶酶原的激活过程，防止纤维蛋白溶解酶降解纤维蛋白。因此，我们在这项研究中比较了接受静脉（IV）或局部 TXA 的 HTO 患者的手术骨出血情况。
回顾性分析了 2016 年 1 月至 2019 年 8 月期间接受开放式楔形 HTO 的 191 例患者（包括接受 IV TXA 的 72 例、接受局部 TXA 的 64 例和 55 例对照组患者）的病历。各组之间无明显的人口统计学差异。在这里，我们使用独立参数评估局部和 IV TXA 减少失血的疗效。
与 IV TXA 组相比，接受局部 TXA 治疗的患者出血量更大（622±231ml 比 451±231ml，平均差异 171ml [95%CI，87-254]；p<0.001）。IV TXA 组的血红蛋白浓度明显高于局部用药组。在整个研究期间，没有患者发生血栓栓塞并发症。
在我们的研究中，静脉或局部使用 TXA 似乎都可以减少开放式楔形 HTO 后的出血量，与局部组相比，IV TXA 组的出血量和引流量明显减少。
