Department of Orthopaedics and Traumatology, Eskisehir Yunus Emre State Hospital, Eskisehir, Turkey.
Department of Orthopaedics and Traumatology, Ankara Etlik City Hospital, Ankara, Turkey.
Niger J Clin Pract. 2024 Apr 1;27(4):521-527. doi: 10.4103/njcp.njcp_3_24. Epub 2024 Apr 29.
Blood loss during and after total knee arthroplasty (TKA) can lead to substantial morbidity and the need for blood transfusions. There are several methods to minimize blood loss and decrease transfusion rates in patients undergoing TKA. Tranexamic acid, an antifibrinolytic agent with known efficacy for achieving these goals, is combined with tourniquets to reduce bleeding in arthroplasty surgeries. Our study investigated the effects of various combinations of tranexamic acid and tourniquet use on bleeding in knee arthroplasty in 558 patients.
We aimed to determine the method that would provide the least blood loss and transfusion need in knee arthroplasty surgery.
Between January 2018 and December 2022, 558 patients aged between 55 and 85 years underwent TKA surgery for grade 4 gonarthrosis in our clinic, and their decrease in hemoglobin value and whether they were transfused or not were analyzed. The patients were divided into four groups based on use of tranexamic acid and tourniquet. Demographic variables and patient data (body mass index, INR values, and preoperative hemoglobin values) were recorded.
There were 558 patients with a mean age of 68.19 (67 ± 6.949) years. In group 1, tranexamic acid was not used in 128 patients and tourniquet was used only during cementation; in group 2, in 132 patients, tranexamic acid was not used and tourniquet was used throughout the surgery; in group 3, in 158 patients, tranexamic acid was used and tourniquet was used throughout the surgery; in group 4, in 140 patients, tranexamic acid was used and tourniquet was used only during cementation. The decrease in hemoglobin value and transfusion rate was lowest in group 3 and highest in group 1. Besides, there was a greater decrease in hemoglobin value in group 2 than in group 4 and the transfusion rate was similar.
This clinical study showed that using tranexamic acid and a tourniquet throughout surgery significantly reduced the decrease in hemoglobin value and the need for transfusion.
全膝关节置换术（TKA）过程中和之后的失血可导致严重发病率和输血需求。有几种方法可以减少 TKA 患者的失血量和输血率。氨甲环酸是一种已知可实现这些目标的抗纤维蛋白溶酶药物，与止血带联合使用可减少关节置换术中的出血。我们的研究调查了在 558 例膝关节置换术患者中，不同组合的氨甲环酸和止血带使用对膝关节出血的影响。
我们旨在确定在膝关节置换术中提供最少失血和输血需求的方法。
2018 年 1 月至 2022 年 12 月，我们诊所对 558 例年龄在 55 至 85 岁之间的 4 级膝关节骨关节炎患者进行了 TKA 手术，分析了他们的血红蛋白值下降情况以及是否输血。根据是否使用氨甲环酸和止血带将患者分为四组。记录了人口统计学变量和患者数据（体重指数、INR 值和术前血红蛋白值）。
共有 558 例患者，平均年龄为 68.19（67 ± 6.949）岁。在第 1 组中，128 例患者未使用氨甲环酸，仅在骨水泥固定时使用止血带；在第 2 组中，132 例患者未使用氨甲环酸，手术全程使用止血带；在第 3 组中，158 例患者使用氨甲环酸，手术全程使用止血带；在第 4 组中，140 例患者使用氨甲环酸，仅在骨水泥固定时使用止血带。第 3 组的血红蛋白值下降和输血率最低，第 1 组最高。此外，第 2 组的血红蛋白值下降比第 4 组更大，输血率相似。
本临床研究表明，手术全程使用氨甲环酸和止血带可显著减少血红蛋白值下降和输血需求。
