Matsuda Shogo, Miyazaki Masashi, Hirakawa Masashi, Nagashima Yu, Akase Hiroya, Kaku Nobuhiro
Orthopedic Surgery, Oita University, Yufu, JPN.
Orthopedics, Oita University, Yufu, JPN.
Cureus. 2024 Jul 17;16(7):e64780. doi: 10.7759/cureus.64780. eCollection 2024 Jul.
Introduction Intraoperative and postoperative bleeding in total knee arthroplasty (TKA) affects postoperative outcomes. Although the hemostatic effect of a flowable gelatin hemostatic matrix (FGHM) is known across several surgical fields, its effectiveness on TKA remains controversial. This study aimed to compare the amount of bleeding across three groups treated with different doses of FGHM in TKA. Methods Overall, 122 knee joints of patients who underwent unilateral primary TKA were included and divided into three groups according to FGHM dose: absence of FGHM (control group, N=48), administration of 5 mL of FGHM (5 mL group, N=46), and administration of 8 mL of FGHM (8 mL group, N=38). Total hemoglobin (Hb) loss, drain output, hidden blood loss (HBL), calculated total blood loss (TBL) on the first postoperative day (POD1) and one week postoperatively (POD7), postoperative flexion angle at one week and discharge, and incidence of postoperative deep venous thrombosis (DVT) were assessed. Results At POD1, the mean total Hb losses were 6.3±3.1g (control group), 5.5±3.3g (5 mL group), and 5.3±2.5g (8 mL group), with no significant differences. At POD7, the mean Hb losses were 9.1±4.6g (control), 8.7±3.6g (5 mL), and 8.3±4.0g (8 mL), also with no significant differences. Mean drain outputs and HBLs showed no significant differences among groups. While there was a decreasing trend in TBL with higher FGHM doses, it was not statistically significant at either POD1 or POD7. There were no statistically significant differences in the mean postoperative flexion angle at POD7 or discharge among the groups (99.7±12.6°, 95.7±12.5°, 98.3±13.8° at POD7; 115.9±9.7°, 113.8±9.6°, 116.6±9.2° at discharge). Of these, only one patient in the 8 mL group developed proximal DVT. Conclusion Despite a trend towards decreased bleeding with FGHM, no significant differences were found among the three groups. However, the clinical utility of this hemostatic agent for reducing blood loss after primary TKA remains still unclear.
全膝关节置换术（TKA）中的术中及术后出血会影响术后结果。尽管可流动明胶止血基质（FGHM）在多个手术领域的止血效果已为人所知，但其在TKA中的有效性仍存在争议。本研究旨在比较TKA中接受不同剂量FGHM治疗的三组患者的出血量。方法：总共纳入了122例行单侧初次TKA的患者膝关节，并根据FGHM剂量分为三组：未使用FGHM（对照组，N = 48）、使用5 mL FGHM（5 mL组，N = 46）和使用8 mL FGHM（8 mL组，N = 38）。评估术后第1天（POD1）和术后1周（POD7）的总血红蛋白（Hb）丢失量、引流液量、隐性失血量（HBL）、计算得出的总失血量（TBL）、术后1周及出院时的术后屈曲角度以及术后深静脉血栓形成（DVT）的发生率。结果：在POD1时，并计算得出的总失血量（TBL），三组之间也无显著差异。在POD7时，平均Hb丢失量分别为对照组9.1±4.6g、5 mL组8.7±3.6g、8 mL组8.3±4.0g，同样无显著差异。平均引流液量和HBL在各组之间无显著差异。虽然随着FGHM剂量增加TBL有下降趋势，但在POD1或POD7时均无统计学意义。各组在POD7或出院时的平均术后屈曲角度也无统计学显著差异（POD7时分别为99.7±12.6°、95.7±12.5°、98.3±13.8°；出院时分别为115.9±9.7°、113.8±9.6°、116.6±9.2°）。其中，8 mL组仅1例患者发生近端DVT。结论：尽管FGHM有减少出血的趋势，但三组之间未发现显著差异。然而，这种止血剂在初次TKA后减少失血的临床实用性仍不明确。
