CAJ | 학술논문

目的：探讨关节腔注射氨甲环酸（ TXA）对全膝关节置换术（ TKA）术后出血量、术后功能恢复及术后并发症的影响。方法因骨性关节炎（ OA）行全膝关节置换术的患者46例，随机分为氨甲环酸组（ A组，23例），对照组（ B组，23例），A组于手术缝皮结束后关节腔注射氨甲环酸（2．0 g氨甲环酸溶入20 mL生理盐水），B组注射20 mL生理盐水，均夹闭引流管2 h。比较两组术后可见失血量、输血例数、输血量、术后血红蛋白（Hb）及红细胞比容（HCT），术后6周随访膝关节HSS评分及下肢深静脉血栓（ DVT）或肺栓塞发生情况。结果两组患者术后可见失血量、输血例数、输血量、术后Hb及HCT比较差异均有统计学意义（ P＜0．05）。比较两组术中、术后3小时纤维蛋白原（Fg）、凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）差异无统计学意义（P＞0．05）。两组患者膝关节HSS评分差异无统计学意义（P＞0．05）。46例患者术后2周行下肢血管多普勒超声检查未发现DVT形成，术后6周随访未发现下肢DVT或肺栓塞发生。结论关节腔注射氨甲环酸在全膝关节置换术后能明显降低患者术后失血量及输血率，并且没有增加下肢DVT形成的风险。
목적：탐토관절강주사안갑배산（ TXA）대전슬관절치환술（ TKA）술후출혈량、술후공능회복급술후병발증적영향。방법인골성관절염（ OA）행전슬관절치환술적환자46례，수궤분위안갑배산조（ A조，23례），대조조（ B조，23례），A조우수술봉피결속후관절강주사안갑배산（2．0 g안갑배산용입20 mL생리염수），B조주사20 mL생리염수，균협폐인류관2 h。비교량조술후가견실혈량、수혈례수、수혈량、술후혈홍단백（Hb）급홍세포비용（HCT），술후6주수방슬관절HSS평분급하지심정맥혈전（ DVT）혹폐전새발생정황。결과량조환자술후가견실혈량、수혈례수、수혈량、술후Hb급HCT비교차이균유통계학의의（ P＜0．05）。비교량조술중、술후3소시섬유단백원（Fg）、응혈매원시간（PT）화활화부분응혈활매시간（APTT）차이무통계학의의（P＞0．05）。량조환자슬관절HSS평분차이무통계학의의（P＞0．05）。46례환자술후2주행하지혈관다보륵초성검사미발현DVT형성，술후6주수방미발현하지DVT혹폐전새발생。결론관절강주사안갑배산재전슬관절치환술후능명현강저환자술후실혈량급수혈솔，병차몰유증가하지DVT형성적풍험。
Objective To explore the effect of articular cavity injection of tranexamic acid on blood loss ,function recovery and post-operative complication after total knee arthroplasty .Methods Forty-six patients who got total knee arthroplasty caused by osteoarthritis ( OA) from Jan 2012 to Aug 2013 were selected and randomly divided into group A with topical application of tranexamic acid (23 cases) and group B(23 cases).Patients in group A were all injected 2.0g tranexamic acid with 20ml normal saline into articular cavity after ending seam skin surgery,while those in group B were injected 20ml normal saline and closed drainage tube 2h.The postoperative blood loss ,number of blood transfusion and blood transfusion volume,post operative hemoglobin(Hb) and hematocrit(Hct),6W postoperative knee HSS score,lower ex-tremity deep vein thrombosis ( DVT) or pulmonary embolism were compared between the two groups .Results Intraoperative total postopera-tive blood loss ,the number of blood transfusion and blood transfusion volume ,postoperative hemoglobin and hematocrit between the two groups indicated statistical significance(P<0.05).The postoperative 3h fibrinogen(Fg),prothrombin time(PT) and activated partial thromboplastin time(APTT) of the two groups had no statistical significance (P>0.05).The postoperative knee HSS scores of the two groups indicated no statistical significance (P 0.05).DVT was not found in 46 cases of patients by lower limb vascular Doppler ultrasound examination after oper -ating 2w,and neither were lower limb DVT or pulmonary embolism found by flowing up visiting in 6w postoperative.Conclusion Articular cavity injection of tranexamic acid can obviously decrease the postoperative blood loss and transfusion rate ,and it also doesn't increase the risk of DVT occurrence at the end of total knee arthroplasty .