| Background:Total knee arthroplasty(TKA)is an effective method for the treatment of pain and motor dysfunction of the end-stage knee joint disease.TKA can improve the patient’s quality of life and meet the needs of the patient’s daily activities.The number of patients receiving TKA is increasing year by year.The primary diseases are osteoarthritis and rheumatoid arthritis.However,blood loss in the perioperative period of TKA is one of the important factors that affect the recovery of the patients.Tranexamic acid(TXA)is one of the several effective strategies being used to reduce the blood loss,the beneficial effects of intravenous injection(IV)TXA have been identified.However,the effects of different Administration Ways in TKA have not been fully evaluated.In addition,most previous studies have focused on the unilateral total knee arthroplasty,but the research of tranexamic acid being used in bilateral total knee arthroplasty in the same period is very few,this makes the using of TXA in perioperative period difficult,it needs us to study further to indentify better administration ways and dosage for unilateral TKA and bilateral TKA at the same time to provide the basis for better application of tranexamic acid in TKA.Objective:As a retrospective study in this study,through comparing the efficacy and safety of intra-articular injection of TXA(IA)combined with intravenous injection of TXA(IV)and intravenous injection(IV)in reducing postoperative hemoglobin decreasing,blood transfusion,drainage and postoperative hospitalization time,providing corresponding basis for the clinical application.Methods:Patients receiving primary total knee arthroplasty from the January of 2016 to the January of 2018 in the department of joint in the second hospital of Jilin University are conducted in our retrospective study,108 cases are included in the retrospective analysis,20 cases are screened out,of which 10 cases have low preoperative hemoglobin values less than the specified value,10 cases suffer from other diseases were excluded.Finally,88 cases meet the conditions,22 cases in group A,receiving 1.0g /100 ml tranexamic acid only through intravenous injection before skin incision of TKA and intravenous drip of tranexamic acid 1.0g /100 ml 3h and 6h after skin incision;22 cases in group B,receiving intravenous drip of 1.0g /100 ml TXA before skin incision of TKA,and retrograde infusion of 1.0g /100 ml TXA into articular cavity after skin incision was closed and intravenous drip of tranexamic acid 1.0g /100 ml 3h and 6h after skin incision;22 cases in group C,receiving intravenous drip of 1.0g/100 ml TXA before skin incision of bilateral surgery respectively and intravenous drip of tranexamic acid 1.0g /100 ml 3h after the second skin incision of bilateral TKA;22 cases in group D,receiving intravenous drip of 1.0g /100 ml TXA before skin incision of bilateral surgery respectively,and retrograde infusion of 1.0g /100 ml TXA into articular cavity after skin incision was closed in bilateral surgery respectively and intravenous drip of tranexamic acid 1.0g /100 ml 3h after the second skin incision of bilateral TKA.Then the drainage tube was opened three hours after clipping.The average operation time,the postoperative hospitalization time,postoperative drainage volume,the mean transfusion amount,the Hb values preoperation,at the first day and third day postoperation,the preoperative hematocrit(HCT)and HCT values at the first day and third day postoperation,the occurrence rate of postoperative complication(pulmonary embolism,deep venous thrombosis,etc)of patient during the perioperative period were recorded.Statistical analysis was carried out on observed clinical results,It indicated that the difference had statistical significance between two groups when P<0.05.Results:Unilateral total knee arthroplasty:The average drainage volume of A group is more than B group after operation,the difference has statistical significance between the two groups(P<0.05);the different mean Hb and HCT values preoperation between the two groups have no statistical significance(P>0.05);the average HCT and Hb values of the first day after surgery have statistical significance(P<0.05),the average HCT and Hb values of the third day after surgery have statistical significance(P<0.05);the operation time,general conditions between the two groups such as age,body mass index and other aspects of the two groups have no statistical significance(P>0.05);blood transfusion amount between two groups during the perioperative period,hospitalization time after operation and complication rate have no difference.Bilateral total knee arthroplasty:The average drainage volume of C group is more than D group after operation,the difference has statistical significance between the two groups(P<0.05);the different mean Hb and HCT values preoperation between the two groups have no statistical significance(P>0.05),the average HCT and Hb values of the third day postoperation have no statistical significance(P>0.05);the average HCT and Hb values of the first day after surgery have statistical significance(P<0.05);the general conditions between the two groups such as age,body mass index,operation time and other aspects of the two groups have no statistical significance(P>0.05);blood transfusion amount of two groups during the perioperative period and hospitalization time after operation and have statistical significance(P<0.05),complication rate have no difference.Conclusion:Compared with the application of intravenous TXA,the application of intra-articular combined with intravenous TXA can effectively reduce the postoperative drainage volume and hemoglobin loss in the perioperative period in both unilateral TKA and bilateral TKA,not increasing the risk of postoperative thrombus complication;compared with the application of intravenous TXA,blood transfusion amount during the perioperative period and hospitalization time after operation are less in bilateral TKA,transfusion amount during the perioperative period and hospitalization time after operation are not less in unilateral TKA. |
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