Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Orthopaedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China.
Orthop Surg. 2024 Oct;16(10):2447-2453. doi: 10.1111/os.14177. Epub 2024 Jul 28.
In addition to the surface hemorrhage of cancellous bone after large-area osteotomy, the intramedullary hemorrhage after the reamed knee joint is also a major cause of postoperative bleeding after total knee arthroplasty (TKA). This study evaluated the efficacy and safety of bone wax application at different time points of prone hemorrhage to reduce perioperative blood loss.
From August 2023 to December 2023, 150 patients undergoing primary unilateral TKA were included in this prospective, randomized controlled trial, patients were randomly divided into three groups: group A, after autogenous osteotomy plug was used to fill the femoral medullary cavity, the residual space was sealed with bone wax and the exposed cancellous bone surface around the prosthesis was coated with bone wax after the prosthesis adhesion; group B, only the exposed cancellous bone surface around the prosthesis was coated with bone wax; and group C, no bone wax was used. The primary outcome was total perioperative blood loss. Secondary outcomes included occult blood loss, postoperative hemoglobin reduction, blood transfusion rate, lower limb diameter, and knee function, while length of hospital stay was recorded. Tertiary outcomes included the incidence of postoperative related adverse events.
The total blood loss in group A (551.5 ± 224.5 mL) and group B (656.3 ± 267.7 mL) was significantly lower than that in group C (755.3 ± 248.3 ml, p < 0.001), and the total blood loss in group A was also lower than that in group B (p < 0.05). There were also significant differences in the reduction of hemoglobin level and hidden blood loss among the three groups (p < 0.05). However, there was no significant improvement in postoperative lower limb swelling, knee joint activity and hospitalization time; there was no significant difference in the incidence of complications such as thromboembolism.
The use of bone wax in TKA can safely and effectively reduce perioperative blood loss and hemoglobin drop rate, and multiple use at time points during the operation when blood loss is prone to occur can produce more significant hemostatic effect.
除大面积截骨术后的松质骨表面出血外，扩髓后髓内出血也是全膝关节置换术后出血的主要原因。本研究评估了在俯卧位出血的不同时间点使用骨蜡以减少围手术期失血的效果和安全性。
2023 年 8 月至 2023 年 12 月，前瞻性随机对照试验纳入了 150 例行初次单侧 TKA 的患者，患者被随机分为三组：A 组，在使用自体骨块填充股骨髓腔后，用骨蜡封闭残腔，在假体附着后涂覆假体周围暴露的松质骨表面；B 组，仅涂覆假体周围暴露的松质骨表面；C 组，不使用骨蜡。主要结局是总围手术期失血量。次要结局包括隐性失血量、术后血红蛋白降低、输血率、下肢直径和膝关节功能，同时记录住院时间。三级结局包括术后相关不良事件的发生率。
A 组（551.5±224.5ml）和 B 组（656.3±267.7ml）的总失血量明显低于 C 组（755.3±248.3ml，p<0.001），A 组也明显低于 B 组（p<0.05）。三组血红蛋白水平下降和隐性失血减少也有显著差异（p<0.05）。然而，术后下肢肿胀、膝关节活动度和住院时间无明显改善；血栓栓塞等并发症的发生率无显著差异。
TKA 中使用骨蜡可以安全有效地减少围手术期失血量和血红蛋白下降率，在容易发生出血的手术时点击使用可以产生更显著的止血效果。
