| With the continuous development of China's economy,people's living standards improved significantly compared with the previous,China's population aging problem is getting heavier,by the knee osteoarthritis disease disorders more and more patients.Knee osteoarthritis has seriously affected people's quality of life.But people on the quality of life requirements are getting higher and higher.So more and more people choose the artificial knee surface replacement surgery.Today,artificial prosthetic material replacement,prosthetic design more reasonable,prosthetic life longer and longer.TKA surgery has the effect of effectively relieving knee pain,good knee function reconstruction,etc.,has become the preferred treatment of knee osteoarthritis.But TKA postoperative osteotomy bone and intramedullary hemorrhage,and some patients had surgery after allogeneic blood transfusion.But the clinical use of blood and blood,patients and clinicians suffering from allogeneic blood transfusion window period of infectious diseases.A new method of reducing the bleeding caused by surgical trauma,and reducing the risk of postoperative transfusion and the corresponding loss of new methods came into being.At home and abroad there are many reports in TKA intravenous or local use of tranexamic acid can reduce postoperative blood loss.But for how the current use of carbamate can achieve the best results,there is no uniform advice.Tranexamic acid use of local joint cavity and the use of intravenous injection effect is also very controversial.There are a lot of relevant research and reports both at home and abroad,but there is no uniform conclusion.Local use of tranexamic acid should be in the surgical operation after the end of the drainage tube for a period of time,the purpose is to increase the concentration of local tranexamic acid,the drug effect to the maximum.So this study after the closure of drainage tube 4 hours,so that the role of tranexamic acid asmuch as possible to extend the maximum effect.Objective: To investigate the effect of topical application of tranexamic acid in the knee joint on the blood loss and the incidence of complications after initial knee arthroplasty.Methods: The use of Hebei Medical University Third Hospital medical system collection from August 2014 to December 2014 in our department line unilateral artificial knee surface replacement and for posterior cruciate ligament retained bone cement fixed artificial knee prosthesis(Germany Link Company),by the same senior joint surgery expert surgeon artificial knee surface replacement surgery cases,according to the inclusion,excluding the standard one by one screening.A total of 104 patients were enrolled in the study.Group A was treated with tranexamic acid(15 mg / kg)for group A and group A without methotrexate.After the hemostatic tourniquet with positive knee longitudinal incision,patellar medial approach into the joint cavity,complete the knee femur,tibial osteotomy,patella are not replaced.Install the knee prosthesis test,move the knee to test the activity and stability.And then remove the test mode,rinse the osteotomy,the installation of bone cement prosthesis.Group A was injected with 20 ml of 0.9% sodium chloride injection of tranexamic acid(15 mg / kg)diluted with dilution to the knee joint cavity 5 minutes before the drainage tube was placed in the drainage tube sutured the tourniquet.Group after the drainage into the same amount of saline.Loose hemostasis after the strict hemostasis,the placement of drainage tube within the joint cavity,one by one seam surgery area incision,limb pressure bandage.Two groups were postoperatively for 4 hours.The differences of sex,age,course of disease,intraoperative blood loss,postoperative drainage,postoperative total blood loss,occult blood loss,postoperative hemoglobin content,postoperative hematocrit,postoperative complications and so on were analyzed.After the fourth day of deep vein ultrasound examination whether the deep vein thrombosis.Results: There were no significant differences in sex,age,course of disease,body mass index and preoperative D-dimer between the two groups(P> 0.05).There was no significant difference between the two groups(P>0.05).There was no significant difference between the two groups(P> 0.05).The total drainage volume,total blood loss and recessive blood loss were The hematocrit and hemoglobin in group A were significantly higher than those in group B(P <0.05).The difference was statistically significant(P <0.05),and the difference was statistically significant(See Table 2).There were 7 cases(13%)and 12 cases(37%)in group A and B,respectively.The difference between the two groups was statistically significant(P <0.05).There was no significant difference in the incidence of deep venous thrombosis between the two groups(P> 0.05).There were no cases of pulmonary embolism in both groups.Conclusion: The use of tranexamic acid in the initial artificial knee joint replacement can significantly reduce postoperative blood loss,reduce blood transfusion rate and blood transfusion,and do not increase the incidence of complications such as thromboembolism and postoperative infection. |
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