中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
40期
6397-6402
,共6页
植入物%人工假体%氨甲环酸%髋关节置换%关节腔注射%间断夹管%出血
植入物%人工假體%氨甲環痠%髖關節置換%關節腔註射%間斷夾管%齣血
식입물%인공가체%안갑배산%관관절치환%관절강주사%간단협관%출혈
arthroplasty,replacement,hip%tranexamic acid%hemorrhage%venous thrombosis
背景：随着全髋关节置换患者的增多，血源越来越紧张，同时输血感染各种严重疾病的风险也困扰者患者，故寻找一种减少输血并且不增加风险的方法显得很重要。目前国内外已有在全膝、全髋关节置换及脊椎手术中使用氨甲环酸减少出血的报道。<br> 目的：探讨关节腔注射氨甲环酸及间断夹管对全髋关节置换后出血量、功能恢复及并发症的影响。<br> 方法：选取2011年1月至2014年2月因股骨颈骨折或髋关节骨关节炎行全髋关节置换的患者99例，氨甲环酸组55例，对照组44例。氨甲环酸组于置换缝皮结束后关节腔注射2.0 g氨甲环酸(溶入20 mL生理盐水)，置换后间断2 h后放开引流，此后每4 h放10 min。对照组间断夹管引流，置换后48 h均拔出负压引流管。比较两组患者置换后可见失血量、输血例数、输血量、置换后24 h血红蛋白及红细胞比容，置换前、置换后3 h纤维蛋白原、凝血酶原时间及活化部分凝血活酶时间，置换后6个月随访髋关节Harris评分及下肢深静脉血栓或肺栓塞形成情况。<br> 结果与结论：两组患者置换后可见失血量、输血例数、输血量、置换后24 h血红蛋白及红细胞比容比较差异均有显著性意义(P<0.05)，氨甲环酸组明显优于对照组。两组置换前、置换后3 h纤维蛋白原、凝血酶原时间和活化部分凝血活酶时间差异无显著性意义(P>0.05)。两组患者置换后6个月髋关节Harris评分差异无显著性意义(P>0.05)。99例患者置换后3次(3，10，14 d)行下肢血管多普勒超声检查未发现深静脉血栓形成，置换后6个月随访未发现下肢深静脉血栓或肺栓塞发生。提示关节腔注射氨甲环酸及间断夹管在全髋关节置换后能明显降低患者置换后失血量及输血率，并且未增加下肢深静脉血栓形成的风险。
揹景：隨著全髖關節置換患者的增多，血源越來越緊張，同時輸血感染各種嚴重疾病的風險也睏擾者患者，故尋找一種減少輸血併且不增加風險的方法顯得很重要。目前國內外已有在全膝、全髖關節置換及脊椎手術中使用氨甲環痠減少齣血的報道。<br> 目的：探討關節腔註射氨甲環痠及間斷夾管對全髖關節置換後齣血量、功能恢複及併髮癥的影響。<br> 方法：選取2011年1月至2014年2月因股骨頸骨摺或髖關節骨關節炎行全髖關節置換的患者99例，氨甲環痠組55例，對照組44例。氨甲環痠組于置換縫皮結束後關節腔註射2.0 g氨甲環痠(溶入20 mL生理鹽水)，置換後間斷2 h後放開引流，此後每4 h放10 min。對照組間斷夾管引流，置換後48 h均拔齣負壓引流管。比較兩組患者置換後可見失血量、輸血例數、輸血量、置換後24 h血紅蛋白及紅細胞比容，置換前、置換後3 h纖維蛋白原、凝血酶原時間及活化部分凝血活酶時間，置換後6箇月隨訪髖關節Harris評分及下肢深靜脈血栓或肺栓塞形成情況。<br> 結果與結論：兩組患者置換後可見失血量、輸血例數、輸血量、置換後24 h血紅蛋白及紅細胞比容比較差異均有顯著性意義(P<0.05)，氨甲環痠組明顯優于對照組。兩組置換前、置換後3 h纖維蛋白原、凝血酶原時間和活化部分凝血活酶時間差異無顯著性意義(P>0.05)。兩組患者置換後6箇月髖關節Harris評分差異無顯著性意義(P>0.05)。99例患者置換後3次(3，10，14 d)行下肢血管多普勒超聲檢查未髮現深靜脈血栓形成，置換後6箇月隨訪未髮現下肢深靜脈血栓或肺栓塞髮生。提示關節腔註射氨甲環痠及間斷夾管在全髖關節置換後能明顯降低患者置換後失血量及輸血率，併且未增加下肢深靜脈血栓形成的風險。
배경：수착전관관절치환환자적증다，혈원월래월긴장，동시수혈감염각충엄중질병적풍험야곤우자환자，고심조일충감소수혈병차불증가풍험적방법현득흔중요。목전국내외이유재전슬、전관관절치환급척추수술중사용안갑배산감소출혈적보도。<br> 목적：탐토관절강주사안갑배산급간단협관대전관관절치환후출혈량、공능회복급병발증적영향。<br> 방법：선취2011년1월지2014년2월인고골경골절혹관관절골관절염행전관관절치환적환자99례，안갑배산조55례，대조조44례。안갑배산조우치환봉피결속후관절강주사2.0 g안갑배산(용입20 mL생리염수)，치환후간단2 h후방개인류，차후매4 h방10 min。대조조간단협관인류，치환후48 h균발출부압인류관。비교량조환자치환후가견실혈량、수혈례수、수혈량、치환후24 h혈홍단백급홍세포비용，치환전、치환후3 h섬유단백원、응혈매원시간급활화부분응혈활매시간，치환후6개월수방관관절Harris평분급하지심정맥혈전혹폐전새형성정황。<br> 결과여결론：량조환자치환후가견실혈량、수혈례수、수혈량、치환후24 h혈홍단백급홍세포비용비교차이균유현저성의의(P<0.05)，안갑배산조명현우우대조조。량조치환전、치환후3 h섬유단백원、응혈매원시간화활화부분응혈활매시간차이무현저성의의(P>0.05)。량조환자치환후6개월관관절Harris평분차이무현저성의의(P>0.05)。99례환자치환후3차(3，10，14 d)행하지혈관다보륵초성검사미발현심정맥혈전형성，치환후6개월수방미발현하지심정맥혈전혹폐전새발생。제시관절강주사안갑배산급간단협관재전관관절치환후능명현강저환자치환후실혈량급수혈솔，병차미증가하지심정맥혈전형성적풍험。
BACKGROUND:With the increased number of patients with total hip arthroplasty, blood source became less gradual y. Simultaneously, the risk of a variety of serious diseases infected by blood transfusion troubled the patients. Thus, it is very important to find a method that can reduce blood transfusion and did not increase risk. There are reports addressing the application of tranexamic acid to reduce bleeding during total knee, total hip arthroplasty and spinal surgery. <br> OBJECTIVE:To explore the effects of injection with tranexamic acid through articular cavity and discontinuous clip pipe on blood loss, functional recovery and complication after total hip arthroplasty. <br> METHODA total of 99 patients, who received total hip arthroplasty because of femoral fracture or coxarthropathy from January 2011 to February 2014, were selected in this study. They were divided into tranexamic acid group (n=55) and control group (n=44). After skin suture, patients in the tranexamic acid group were injected with 2.0 g tranexamic acid dissolved in 20 mL physiological saline through articular cavity. After replacement, the drainage was opened after 2 hours of interval. From then on, the drainage was opened for 10 minutes every 4 hours. Patients in the control group received discontinuous clip pipe. Negative pressure drainage tube was pul ed out at 48 hours after replacement. Blood loss, the number of blood transfusion, blood transfusion volume, 24-hour postoperative hemoglobin and hematocrit, preoperative, 3-hour postoperative fibrinogen, prothrombin time and activated partial thromboplastin time, 6-month postoperative hip Harris score and lower extremity deep vein thrombosis or pulmonary embolism were compared between the two groups. <br> RESULTS AND CONCLUSION:Significant differences in blood loss, the number of blood transfusion, blood transfusion volume, 24-hour postoperative hemoglobin and hematocrit were visible after replacement in patients of both groups (P<0.05). Blood loss, the number of blood transfusion, blood transfusion volume, 24-hour postoperative hemoglobin and hematocrit were better in the tranexamic acid group than in the control group. No significant difference in preoperative, 3-hour postoperative fibrinogen, prothrombin time and activated partial thromboplastin time was detectable between the two groups (P>0.05). No significant difference in 6-month postoperative hip Harris score was found between the two groups (P>0.05). No lower extremity deep vein thrombosis was observed using Doppler ultrasonography at 3, 10 and 14 days after replacement in 99 patients. Lower extremity deep vein thrombosis or pulmonary embolism was not detected at 6 months after replacement. Above data indicated that injection with tranexamic acid through articular cavity and discontinuous clip pipe after total hip arthroplasty could obviously decrease postoperative blood loss and blood transfusion, and did not increase the risk of lower extremity deep vein thrombosis.
