| Background : Total knee arthroplasty(TKA)is one of the most practical and effective surgical methods for the treatment of end-stage knee osteoarthritis.However,massive postoperative blood loss is the main complication of TKA,which is usually related to the massive bleeding of the wound after TKA,which leads to the decrease of hemoglobin in patients.In order to avoid massive blood loss and related complications caused by blood transfusion,clinical orthopedic surgeons are currently considering several countermeasures,such as preoperative collection of patient ’s own blood for postoperative autologous blood transfusion,intraoperative collection of patient ’s blood for autologous blood transfusion after filtration,and intraoperative massive fluid replacement to meet the patient ’s blood transfusion needs.Unless there is a clear contraindication for blood transfusion,preoperative blood preparation for the treatment of anemia after TKA has become a routine treatment for TKA surgery.With the emergence and extensive use of tranexamic acid(TXA)in clinical practice,it has effectively reduced the problem of more blood loss after major orthopedic surgery,especially joint replacement surgery.TXA is a synthetic compound based on lysine.It can be combined with the site on the plasminogen in the body,thus inhibiting the activation of plasminogen,thus playing an anti-fibrinolytic effect in clinical practice.Many studies have shown that TXA local or intra-articular(IA)application reduces postoperative blood loss and correspondingly reduces the number of blood transfusions required after surgery.Objective : To explore the effect of intravenous drip combined with tranexamic acid(TXA)on total blood loss after total knee arthroplasty(TKA).Methods : This study was conducted in the Qingdao Municipal Hospital where the author was located.The inpatient electronic medical record system was used to retrospectively analyze the knee osteoarthritis(KOA)in the first ward of bone and joint and sports medicine from January 2019 to December2021.A total of 80 KOA patients who met the inclusion criteria and exclusion criteria were collected.According to this study,the 80 KOA patients were divided into two groups.They were : intravenous drip TXA group(intravenous drip group,40 people),intravenous drip combined with joint application of TXA group(combined group,40 people).The relevant information of these 80 patients who underwent TKA treatment was accurately collected through the electronic medical record system,including patient name,gender,age,height,weight,etc.The study included indicators of the 80 patients were recorded,including Hb and Hct of the patients before and after the operation for three consecutive days,the circumference of the affected limb of the two groups of patients before and after the operation for three consecutive days,the VAS score of the two groups of patients before and after the operation for three consecutive days,the number of days of hospitalization,and whether the patients had related complications during hospitalization such as deep venous thrombosis(DVT),pulmonary embolism,incision infection,etc.Finally,the blood loss of patients after TKA was calculated by Nadler equation.The obtained data were statistically analyzed using STATA17.0 software to further compare and analyze the clinical efficacy of TXA intravenous drip combined with periarticular application in TKA to reduce postoperative blood loss.Results: There was no significant difference between the two groups in general data: preoperative gender,age,weight,height,etc.(P > 0.05).There was no significant difference in preoperative hematological indicators Hb and Hct(P > 0.05).In the combined group,Hb(128.6 ± 10.3)g / L,Hct(35.84 ± 3.55)% on the first day after operation,Hb(118.5± 10.1)g / L,Hct(32.97 ± 3.70)% on the second day after operation,Hb(110.7 ± 10.3)g / L,Hct(30.89 ± 3.70)% on the third day after operation.In the intravenous group,Hb and Hct were(122.8 ± 8.5)g /L and(32.21 ± 2.77)% on the first day after operation,(111.0 ± 8.9)g / L and(27.59 ± 2.71)% on the second day after operation,and(101.8± 8.7)g / L and(24.52 ± 2.52)% on the third day after operation.By comparison,the values of Hb and Hct in the combined group were higher than those in the intravenous drip group for three consecutive days after operation.P < 0.05 indicated that the difference between the two groups was statistically significant.The hospitalization days of the two groups were(9.60 ± 0.77)days.The combined group was(6.90 ± 0.49)days.P< 0.05 was considered statistically significant.There was no blood transfusion in the two groups of patients in the combined group.The preoperative limb circumference of the two groups was(45.05 ± 0.52)cm in the intravenous drip group and(45.13 ± 0.53)cm in the combined group.There was no significant difference between the two groups(P > 0.05).The circumference of the affected limb in the two groups for three consecutive days after operation:(49.18 ± 0.36)cm on the first day after operation,(49.06 ± 0.49)cm on the second day after operation,and(48.39 ± 0.21)cm on the third day after operation.The combined group was(48.74 ± 0.16)cm on the first day after operation,(48.44 ± 0.20)cm on the second day after operation,and(47.24 ± 0.12)cm on the third day after operation.By comparison,the circumference of the affected limb in the combined group was smaller than that in the intravenous drip group for three consecutive days after operation,and there was no significant difference in P0.05.Comparison of VAS scores between the two groups for three consecutive days after operation: intravenous drip group: first day after operation(6.98± 0.15),second day after operation(6.70 ± 0.46),third day after operation(6.00 ± 0.00).Combined group: the first day after operation(6.63 ± 0.49),the second day after operation(6.17 ± 0.38),the third day after operation(5.17 ± 0.38).The VAS scores of the combined group were lower than those of the intravenous drip group for three consecutive days after operation.P < 0.05 indicated that the difference between the two groups was statistically significant.No complications occurred in the two groups during hospitalization.Finally,the total blood loss of the two groups was calculated by Gross equation.Conclusion: In patients undergoing knee arthroplasty,intravenous drip combined with TXA around the joint can significantly reduce blood loss after TKA,reduce postoperative pain,do not increase the incidence of lower extremity DVT during hospitalization,and reduce the number of days of hospitalization.It is beneficial to the early recovery of knee function after KOA patients,and has better clinical efficacy. |
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