Intraoperative cell salvage versus postoperative autologous blood transfusion in hip arthroplasty: a retrospective service evaluation

INTRODUCTION

A number of ways of reducing blood loss in arthroplasty have been explored, including preoperative autologous transfusion, intraoperative cell salvage and postoperative autologous transfusions. Both intraoperative blood salvage and postoperative retransfusion drains have been shown to be effective in reducing blood loss in total hip arthroplasty. In our department there was a change in practice from using postoperative retransfusion drains to intraoperative cell salvage. To our knowledge no study has directly compared using intraoperative blood salvage and postoperative retransfusion drains alone in total hip arthroplasty.

METHODS

This was a retrospective service evaluation including all primary hip arthroplasty performed under our care between January 2006 and December 2008. Patients were divided into two groups: Group A used a postoperative autologous blood transfusion (ABT) drain and Group B used intraoperative cell salvage.

RESULTS

A total of 144 patients were included in this study: 84 in Group A and 60 in Group B. The mean haemoglobin difference for Group A was 3.96g/dl (standard deviation [SD]: 1.52) and for Group B it was 3.46g/dl (SD: 1.42). The mean haematocrit difference for Group A was 0.12% (SD: 0.05) and for Group B it was 0.10% (SD: 0.04). Using an independent t-test for the comparison of means, a significant difference was found between Group A and B both in regards to haemoglobin difference (p=0.009) and haematocrit difference (p=0.046).

CONCLUSIONS

We feel that intraoperative cell salvage provides a more efficient method of reducing blood loss than postoperative retransfusion in primary total hip replacement. A prospective randomised study would be useful to ascertain any clinical difference between the two methods.     

全髋关节表面置换术与传统全髋关节置换术围手术期总失血量的比较研究

目的比较全髋表面置换术（HRA）和传统全髋置换术（THA）围手术期的总失血量以及术后住院时间,探讨两种术式不同的失血机制及其对手术创伤的影响。方法 2009年1月至2009年12月,选择67例髋关节骨病患者,分为两组分别施行HRA和THA,HRA组34例（34髋）,THA组33例（33髋）THA,两组均为初次单侧关节置换。通过Gross方程,根据身高、体重和手术前后的红细胞压积（Hct）变化差值算出所有患者的总失血量,记录显性失血量（术中出血和术后引流量）,推算出隐性失血量。记录手术时间和术后住院时间,将以上数据进行比较。结果 HRA组总失血量、显性失血量和隐性失血量都与THA组有统计学差异。总失血量HRA组和THA组分别为（1048.0±134.2）ml和（1466.0±167.4）ml,两组间差异有统计学意义（t=11.3,P〈0.05）;术中出血量分别为（542.0±68.9）ml和（625.0±86.3）ml,两组间差异有统计学意义（t=4.4,P〈0.05）;术后引流量分别为（266.0±93.9）ml和（379.0±162.7）ml,两组间差异有统计学意义（t=3.5,P〈0.05）;平均隐性失血量分别为（240.0±43.4）ml和（462.0±71.5）ml,两组间差异有统计学意义（t=15.3,P〈0.05）;平均术后住院时间HRA组也明显缩短,HRA为（4.6±0.9）d,THA为（6.1±0.9）d,两组间差异有统计学意义（t=7.0,P〈0.05）;平均手术时间HRA组则比HA组延长,HRA组为（114±13.9）min,THA组为（87±18.5）min,两组间差异有统计学意义（t=-6.9,P〈0.01）。结论尽管HRA比THA手术时间和手术切口都有延长,但总出血量明显降低,尤其是隐形失血量,术后住院时间也缩短,说明HRA出血相对偏少,创伤相对较小。     

The appropriateness of blood transfusion following primary total hip replacement

INTRODUCTION

A significant proportion of all red cell transfusions are given to patients undergoing elective orthopaedic surgery. Concern over transfusion safety and cost, coupled with evidence showing that restrictive transfusion policies benefit patients, prompted us to audit our blood prescribing practice at Gloucestershire Hospitals NHS Foundation Trust in order to assess the appropriateness of every transfusion episode following elective primary total hip replacement.

METHODS

All patients undergoing a primary total hip replacement in our department over a six-month period were included in the study. Data were collected retrospectively using case note examination and transfusion service data. Standards were dictated by the British Orthopaedic Association guidelines on blood conservation in elective orthopaedic surgery.

RESULTS

Twenty-seven per cent of patients (39/143) were transfused. Forty-six per cent of these (18/39) were transfused inappropriately and twenty-three per cent (9/39) appropriately. Thirteen per cent (5/39) had a valid indication for transfusion but were over-transfused and in eighteen per cent (7/39) the quality of documentation did not allow an assessment to be made. Fifty-two per cent of patients who had surgical drains (29/56) were transfused. Reaudit following staff education and amendments to the local transfusion policy did not demonstrate a reduction in transfusion rates.

CONCLUSIONS

This audit showed that significant potential exists for reducing transfusion rates based on optimising prescribing practice alone. It also demonstrated that changing local practice based on audit data can be challenging.     

骨小梁金属髋臼杯在全髋关节置换术中的应用及近期疗效

目的探讨应用骨小梁金属髋臼杯行全髋关节置换术的近期疗效。方法自2013-01—2015-01采用骨小梁金属髋臼杯行初次全髋关节置换治疗24例(26髋)髋关节疾患。采用Kawamura影像学评价标准观察骨长入情况。结果全部患者均获得平均16(6~28)个月随访,术前Harris髋关节评分为(46.6±10.2)分,末次随访时评分为(88.3±6.3)分,手术前后Harris评分比较差异有统计学意义(P0.05)。X线表现:2例术后发现透亮带,所有患者髋臼假体固定稳定,未出现明显假体移位、假体周围骨溶解征象。其中21髋发现在假体与界面之间有明显骨长入征象。并发症:4例术中出现股骨距裂缝骨折。结论采用骨小梁金属髋臼杯行全髋关节置换术假体骨长入明显,近期疗效满意。     

Pre-operative autologous blood donation versus no blood donation in total knee arthroplasty: a prospective randomised trial

Purpose

During total knee arthroplasty (TKA) blood loss can be significant and in spite of all techniques for reducing blood loss there is still a significant possibility for blood transfusions. For blood loss management during TKA, pre-operative autologous blood donation (PABD) is still a standard of care. In this prospective randomised study we have evaluated the efficacy of PABD in patients undergoing TKA to answer the question whether there is any need for autologous blood donations during TKA and, if yes, for which group of patients.

Methods

Patients were randomised to three groups. In group 1 patients did not donate autologous blood, in group 2 patients donated 1 dose 72 hours prior to TKA and in group 3 patients donated autologous blood 14 days prior to TKA. In all patients haemoglobin, haematocrit, thrombocyte and reticulocyte values, iron concentrations (Fe, unsaturated iron binding capacity, total iron binding capacity), activated partial thromboplastin time, prothrombin time, and intra-operative and post-operative blood loss were measured and compared.

Results

With PABD there was no reduction in allogeneic blood transfusions and a large number of taken doses of autologous blood was discarded, which significantly increased the cost of treatment for these patients. For patients undergoing TKA, PABD can provoke iatrogenic anaemia and thereby increase the likelihood of the need for allogeneic blood transfusion.

Conclusions

Results of our study showed that PABD in non-anaemic patients is not justified and is not economically feasible.     

Hemostatic matrix effects on blood loss after total knee arthroplasty: A randomized controlled trial

Background:

Total knee arthroplasty (TKA) can result in major postoperative blood loss which can impact on the recovery and rehabilitation of patients. It also requires expensive transfusions. The purpose of the study was to investigate whether a hemostatic matrix, composed of cross-linked gelatin and a thrombin solution, would reduce blood loss in patients following TKA.

Materials and Methods:

This was a prospective, randomized, controlled study (Trial registration: Hospital S. Salvatore L’Aquila {"type":"entrez-protein","attrs":{"text":"ADJ00843","term_id":"299023578"}}ADJ00843) conducted in 93 patients. Criteria for participation were unilateral TKA for osteoarthritis, and a preoperative hemoglobin level >13 g/dL. The outcomes measured were postoperative hemoglobin and hematocrit levels measured at 24h, 72 h, and 7 days. The mean total postoperative blood loss was calculated from drainage volume, patient blood volume, hematocrit, and red blood cell volume. In addition, the drain output within 24 h following surgery and any transfusion requirements were determined.

Results:

Hemostatic matrix-treated patients (n = 51) showed significant reductions in calculated postoperative blood loss of 32.3% and 28.7% versus control in men and women, respectively (P < 0.01). Postoperative blood loss after 24 h in drain was significantly less with the hemostatic matrix versus control, as were decreases in hemoglobin levels 7 days post-surgery (each P < 0.01). Three patients in the control group required blood transfusion, whereas no blood transfusions were necessary in the hemostatic matrix group.

Conclusion:

The use of a hemostatic matrix provides a safe and effective means to reduce blood loss and blood transfusion requirements in TKA.     

双侧全髋关节置换术中自体血回输作用探讨

目的 双侧全髋关节置换术病人经常需要输入大量术中及术后异体血,其危险性包括溶血反应、感染乙肝或丙肝、感染HIV或梅毒等.减少异体血输入的最常用方法是采用术中自体血回输.该回顾性研究旨在评价术中自体血回输能否具有减少双侧全髋关节置换术围手术期异体输血总量的作用.方法 自2003年1月至2007年6月期间,行双侧首次全髋关节置换术51例,其中26例采用术中自体血回输(A组),25例未用术中自体血回输(B组),回顾性比较两组病人的性别、年龄、体重、身高、疾病、手术医生、手术时间,术前血红蛋白及红细胞压积,术中出血量、自体血回输量、异体血使用量,术后引流量、异体血使用量,术后1、3、7天血红蛋白和红细胞压积.结果 A组术中自体血回输330.7±122.7ml (100～557ml).术中异体血输入量在A组为661.5±437.3ml,B组为888.0±483.3ml(P=0.085).术后异体血输入量在A组为607.7±672.9ml,B组为328.0±423.8ml(P=0.082).两组之间术中和术后异体血总输入量无统计学差异(A组1269.2±807.8ml,B组1216.0±706.9ml,P=0.804).两组之间术后第1天血红蛋白和红细胞压积无统计学差异,而术后第3天血红蛋白和红细胞压积有统计学差异(P=0.020和P=0.013),术后第7天血红蛋白和红细胞压积又无统计学差异.结论 双侧全髋关节置换术术中自体血回输能够减少术中异体输血量,但不能减少围手术期异体输血总量.     

夹管6小时后开放与自体血回输引流对膝关节表面置换术后并发症的影响

目的探讨人工膝关节表面置换术（TKA）后夹管6h后开放的引流方案相比自体血回输方案对术后并发症的影响。方法接受初始膝关节表面置换手术的骨性关节炎患者91例（103膝）,随机分为夹闭组（53膝）和回输组（50膝）。夹管组TKA术后夹闭引流管6h后开放,回输组术后6h内引流液过滤后回输。统计术后总引流量和自体血回输量、异体血输血量,同步监测术前和术后第1、3、6天血常规,通过Gross方程计算隐性出血量和总失血量。记录手术前后的患肢周径了解肢体肿胀幅度,记录切口愈合等级判断感染并发症,检查术后下肢血管超声排查下肢静脉血栓（DVT）,记录术后关节活动度了解关节粘连情况。结果夹管组总引流量（161.13±138.63）ml,与回输组（798.20±337.93）ml比较有统计学差异（t=12.65,P〈0.01）。夹管组隐性失血量（712.77±338.22）ml,与回输组（793.54±325.50）ml比较无统计学差异（t=1.23,P〉0.05）;但夹管组总失血量（1024.85±422.68）ml,与回输组（1561.54±416.83）ml比较有统计学差异（t=6.48,P〈0.01）。夹管组异体血输注率56.00%,平均输血量（150.94±159.74）ml,与回输组比较无统计学差异[异体血输血率65.31%（x~2=0.90,P〉0.05）,输血量（200.00±169.71）ml（t=1.50,P〉0.05）]。术后第1、3、6天夹管组大腿及小腿周径增幅与回输组无统计学差异（P〉0.05）。术后14d膝关节夹管组活动度（96.53°±6.07°）,与回输组（96.72°±6.85°）比较无统计学差异（t=0.15,P〉0.05）。夹管组出现2例切口乙级愈合,1例股深静脉血栓（DVT）,回输组切口全部甲级愈合,无DVT发生,但是,切口感染率和DVT发生率无组间统计学差异（t=0.17,P〉0.05）。结论 TKA术后引流管暂时夹闭6h后开放的引流方案较自体血回输方案可显著减少术后失血和引流量,不增加异体血输血率和输血量,同时,不影响肢体肿胀程度和术后近期关节活动度,不增加感染、DVT等并发症的风险。     

全髋关节置换术使用氨甲环酸有效性及安全性的Meta分析

目的 通过Meta分析评价抗纤溶药物氨甲环酸（TXA）对全髋关节置换术（THA）有效性及安全性的影响.方法 计算机检索数据库MEDLINE（1966年至2012年4月）、PubMed（1966年至2012年6月）、EMBASE（1966年至2012年6月）、Cochrane图书馆（2012年第1期）、中国生物医学光盘数据库（1978年至2012年6月）、中国生物医学文献数据库（1978年至2012年4月）和维普中文科技期刊数据库（1978年至2012年6月）中关于TXA减少全髋关节置换术出血量的临床随机对照研究,并查阅所有检出文献和相关综述的参考文献作为补充资料,截止到2012年4月.采用RevMan 5.1软件进行统计分析,TXA组与安慰剂组失血量采用均数差评价,输血率、深静脉血栓、肺栓塞症和感染发生率采用优势比评价.结果 共纳入高质量前瞻性随机对照研究10篇.Meta分析结果显示,与安慰剂组比较TXA能够减少全髋关节置换患者术中失血量（均数差值-129.16,95% CI[-195.09,-63.23],P〈0.01）,术后失血量（均数差值-146.46,95% CI[-256.61,-36.31],P〈0.01）,总失血量（均数差值-283.93,95% CI[-469.45,-98.40],P〈0.01）,降低输血率（优势比 0.4,95% CI[0.25,0.65],P〈0.01）,而深静脉血栓、肺栓塞症和感染发生率差异无统计学意义.结论 静脉注射TXA能够减少全髋关节置换手术失血量,降低输血率,不增加深静脉血栓、肺栓塞症和感染的发生风险.     

自体血回输在单侧人工全膝关节表面置换术后的临床观察

目的探讨人工全膝关节表面置换术后自体血回输的安全性、有效性及护理特点。方法使用回顾性质量评估设计,比较了2005-2009年本组行单侧人工全膝关节表面置换术患者120例,其中60例采用自体血回输装置（A组）,60例术后伤口采用常规引流袋引流（B组）。根据患者的临床表现和血红蛋白水平决定异体血的输入量,使术后血红蛋白水平维持在10g/dL以上。比较两组患者术后8h内及术后总引流量;比较两组患者术前、术后第1天、术后第7天的血红蛋白变化及术后平均输血量、输异体血比例。观察两组患者输血后不良反应的发生情况。结果两组患者8h内引流量以及术后总引流量比较,差异均无统计学意义（P〉0．05）。两组患者术前、术后第7天血红蛋白的变化无统计学差异（P〉0．05）,术后第1天血红蛋白的变化有统计学意义（P〈0．05）。A组术后自体血回输量平均为382．5ml,术后有9例接受异体血输血,平均异体血输入量134．3ml;A组所有自体血回输未出现输血反应,无感染等并发症。B组术后23例接受异体血输血,平均异体血输入量252．4ml;B组异体血输血过程中有3例出现发热反应。输异体血的比例为A组15．0％,B组38．3％。结论单侧人工全膝关节表面置换术后使用自体血回输是安全有效的,能够节约血源,避免血液传播疾病的发生,临床效果好,值得推广应用。     

急性高容性血液稀释联合自体血回收回输技术在全髋关节置换手术中的应用及对患者的影响

目的评价急性高容性血液稀释和自体血回收回输技术联合应用对全髋关节置换手术的血液保护效果及其安全性。方法 2010年9月至2012年3月在本组实施全髋关节置换手术、预计出血量〉600ml的120例患者随机分为四组,每组30例：对照组、急性高容性血液稀释组、自体血回输组、急性高容性血液稀释组＋自体血回收回输组。术中、术后对血流动力学指标、凝血功能进行检测,记录术中失血量、输血量,麻醉时间和手术时间,以及评价并发症。结果采用自体回输血技术的患者中约50%患者不用再输异体血,其中自体血回输组未输异体血的比例46.67%、急性高容性血液稀释组＋自体血回收回输组未输异体血比例为60%,而对照组中仅10%的患者不需输入异体血,单纯AHH组为1/3患者未输异体血。与对照组相比,所有采用血液保护措施的患者异体输血量比对照组约少240ml,自体血回输技术的再回收率约为40%;术中、术后各组血流动力学指标和凝血功能指标无明显差异,均保持维持稳定;各种组均未发现与应用血液保护技术有关的并发症。结论联合应用急性高容性血液稀释和自体血回收回输技术,可以明显减少失血量、降低异体输血,对患者影响小,并发症低,对全髋关节置换手术来说是一种安全有效的血液保护技术,值得推广应用。     

Mild hypothermia does not increase blood loss during total hip arthroplasty

BACKGROUND: The effects of mild hypothermia on blood loss are little known. METHODS: Patients, undergoing primary prosthetic hip surgery under spinal anaesthesia, were randomised to the operative procedure, with (n=25) or without (n=25) forced air warming. Core temperature was repeatedly measured from the tympanic membrane. The blood loss was calculated by three different methods; the intraoperative loss was estimated visually. The loss during and after the operation was obtained by determination of lost haemoglobin (the Hb-method). The blood loss during hospital stay was also calculated from the haemoglobin balance. RESULTS: Among controls, core temperature decreased by 1.3+/-0.6 degrees C (mean+/-SD) and in the warmed patients 0.5+/-0.4 degrees C (P<0.0001). Preoperative variables and the number of allogeneic units transfused did not differ between the groups. In controls, the blood loss during operation was, with the visual method, 698+/-314 ml, compared with 665+/-292 ml in warmed patients. With the Hb-method, the loss was 662+/-319 and 657+/-348 ml, respectively. With this method, the external loss during the entire hospital stay was, in controls, 1066+/-441 ml and in the warmed group, 1047+/-413 ml. The balance method yielded 1674+/-646 ml and 1507+/-652 ml, respectively. Indices of blood loss did not differ significantly between groups and there was no covariation between those variables and the decrease in core temperature. CONCLUSIONS: Forced air warming did not decrease the blood loss. Methods for determination of blood loss yielded widely differing results.     

髋关节发育不良全髋置换假体轻度上移放置的中长期疗效

目的探讨髋关节发育不良患者全髋关节置换术中髋臼假体真臼范围内以及适度上移放置对患者功能和假体长期生存率的影响。 方法研究的纳入标准：髋关节发育不良继发骨关节炎,接受全髋关节置换术;使用非骨水泥型髋关节假体;手术均由同一组医生完成。排除标准：失访或随访资料不全;同期行双侧全髋关节置换术;髋关节发育不良继发骨关节炎。2008年1月至2013年12月符合入选标准的26例行全髋关节置换术的髋关节发育不良患者,其中失联及不能完成随访各1人,实际纳入随访24例,男5例,女19例;术时年龄36～80岁,平均(62±11)岁。左髋7例,右髋17例。其中Crowe I型10例、Ⅱ型8例、Ⅲ型6例。长期随访分别评估患者的Harris髋关节评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC),并行骨盆正位、患侧股骨正侧位X线片检查评估假体情况,年龄、随访时间、评分以及手术相关指标分别采用t检验或秩和检验分析。 结果本次随访时间平均(80±23)个月。至末次随访时,Harris髋关节平均评分由术前(43±13)分提高至(91±13)分(Z＝－5.867,P＝0.000),而WOMAC骨关节炎指数由术前(58±13)分降至(10± 4)分(Z ＝－5.957,P＝0.000)。术前患肢与对侧比较平均短缩(10±5)mm,术后患肢短缩减小至(5±4)mm(Z＝－4.525,P＝0.000)。末次随访患者未出现影像学上髋臼和股骨假体松动及下沉。髋臼假体上移距离为3～15 mm,其中髋臼假体上移0～5 mm者8例,上移6～10 mm者7例,上移11～15 mm者9例。末次随访时,3组患者Harris评分和WOMAC评分均较术前显著改善,差异均有统计学意义(Harris：Z ₁＝－3.366,Z ₂＝－5.355,Z ₃＝－3.524;WOMAC：Z ₁＝－3.602,Z ₂＝－3.144,Z ₃＝－3.373;均为P<0.05);但组间比较差异无统计学意义(P>0.05)。 结论髋关节发育不良患者在全髋关节置换术中髋臼假体采用放置在真臼范围内或者小于15 mm的适度上移放置,患者可获得满意的中长期疗效。     

Sciatic nerve compression by an extrapelvic cyst secondary to wear debris after a cementless total hip arthroplasty: A case report and literature review

INTRODUCTIONPolyethylene (PE) wear debris after total hip arthroplasty (THA) may cause formation of a soft tissue mass due to inflammatory reaction. To the best of our knowledge we report the first case in whom the diagnosis was made after examination of the hip, pelvis and lumbar spine with detailed radiological methods and the plain radiographs showed no signs of loosening of the THA.PRESENTATION OF CASEWe report a 52 years-old woman who presented with a cyst causing sciatic irritation in her gluteal region due to wear debris after THA. Magnetic resonance imaging (MRI) was useful in detecting the cyst. Resolution of the cyst occured after subtotal cystectomy and revision of the acetabular components.DISCUSSIONAlthough plain radiographs can show signs of the underlying pathology; such as osteolysis, loosening of the components and wear of the PE liner, they are unable to detect cystic lesions. Cystic lesions may be an early sign of wear debris.CONCLUSIONThis case shows us that sciatic neuropathy with no evidence of nerve root impingement on lumbar MRI in a patient with THA requires also examination of the hip and pelvis with detailed radiological methods, such as MRI, in addition to plain radiography. Removal of the source of debris via revision surgery following subtotal cystectomy leads to the resolution of the remaining portion of the cyst and also relief of the symptoms of sciatic nerve compression.     

应用羟基磷灰石喷涂解剖型股骨假体的中期随访结果

目的 探讨使用羟基磷灰石喷涂解剖型股骨假体的全髋关节置换术的中期随访结果 .方法 对2001年1月至2003年12月使用羟基磷灰石喷涂解剖型股骨假体的全髋关节置换术患者75例90髋进行中期随访,男49例61髋,女26例29髋;患者年龄42～68岁,平均58.4岁.以Harris评分系统进行临床结果 评估,采用配对t检验分别比较未次随访Harris评分与术前Harris评分、术后早期Harris评分之间的差异;拍摄髋关节正、侧位X线片对影像学结果 进行评估.结果 48例56髋获得随访,男29例35髋,女19例21髋;随访时间5～8年,平均7.2年.随访中无翻修病例.术前Harris评分平均(28.2±6.3)分,术后早期(平均1年)平均(93.2±4.8)分,末次随访平均(91.6±4.5)分,优良率100%.末次随访Harris评分与术前比较差异有统计学意义(P<0.05),与术后早期比较差异无统计学意义(P>0.05).随访期间出现人腿痛3例.X线片显示全部假体均获得稳定的骨长入,出现股骨近端局限性骨溶解2例、假体柄远端骨质硬化3例、假体刷围间断透光线6例,无一例出现假体下沉和假体内外翻.结论 羟基磷灰石喷涂解剖犁股骨假体应用于全髋关节置换术的中期随访结果 满意,假体可以获得稳定的骨长入,但远期疗效有待进一步观察.     

全髋关节及全膝关节置换术后隐性失血的临床影响

目的探讨人工全髋关节置换术（THA）和人工全膝关节置换术（TKA）术后隐性失血的相关机制及对临床的影响.方法2001年3月至2005年5月,行THA 61例,其中男22例,女39例;年龄61～79岁,平均68岁.同期行TKA73例,其中男23例,女50例;年龄65～77岁,平均73岁.所有病例均为初次行单侧关节置换的患者,24h补液总量不超过2000ml.通过Gross方程,根据身高、体重和手术前后的红细胞压积（Hct）计算所有患者的总失血量,减去显性失血部分后即得隐性失血.结果THA组的总失血量平均为1520ml,隐性失血量为482 ml（32%）;TKA组的总失血量平均为1508 ml,隐性失血量为776 ml（52%）,两组的隐性失血量比较差异有统计学意义（P＜0.01）.TKA组中使用引流血回输患者的总失血量平均为1625 ml,隐性失血量为774ml（48%）;未使用引流血回输患者的总失血量平均为1345 ml,隐性失血量为783 ml（58%）,两组的隐性失血量相比差异无统计学意义;THA与TKA肥胖组和非肥胖组的隐性失血量相比差异均无统计学意义.结论TKA隐性失血远较THA高,且使用引流血回输仍不能完全满足机体恢复体循环的需要,应特别注意及时补充血容量.对隐性失血的正确认识有助于提高临床评估能力,帮助关节置换患者度过围手术期.     

Platelet-rich plasma prevents blood loss and pain and enhances early functional outcome after total knee arthroplasty: a prospective randomised controlled study

Purpose

The purpose of this study was to determine whether platelet-rich plasma (PRP) might prevent blood loss and postoperative pain and expedite wound healing following total knee arthroplasty (TKA).

Methods

Forty consecutive patients with knee arthritis who were matched for age, sex and body mass index (BMI) were randomly allocated to either receive or not receive PRP application over the wound, including capsule, medial and lateral recesses, during TKA. Postoperative haemoglobin, blood loss, blood transfusion, visual analogue scale (VAS) score, wound score, Knee Society Score (KSS) and Western Ontario and McMaster Osteoarthritis Index (WOMAC) score were recorded and evaluated.

Results

The platelet-rich plasma and control groups comprised 17 and 23 patients, respectively. The PRP group recorded significantly less reduction in haemoglobin and need for blood transfusion (p = 0.00 and p = 0.001, respectively), experienced less pain (p = 0.00) and required fewer narcotics than the control (p = 0.00). There was significant difference in range of motion (ROM) at three months (p = 0.01), no significant difference in wound scores (p = 0.311) and significant difference in KSS and WOMAC scores at 12 weeks (p = 0.00, 0.00). However no significant difference was found at six months.

Conclusions

PRP has significant effect in preventing blood loss, postoperative pain and need for narcotics after TKA and has a positive effect on short-term clinical outcome.     

Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty

Purpose

The goal of this study was to analyse the efficacy of blood autotransfusion using a continuous autologous transfusion system in revisions of total hip arthroplasty (THA). We looked at whether administration of allogeneic blood units was reduced in these cases and if there is a difference between cemented and non-cemented revisions.

Methods

Between January 2011 and December 2011, patients being treated with revision THA were included (n = 411). The following parameters were analysed: patient age, gender, weight (kg), height (cm), body mass index (BMI, kg/m²), surgical diagnosis, treatment and American Society of Anesthesiologists (ASA) classification score. The difference between pre- and post-operative haemoglobin (Hb, g/dl), amount of peri-operative blood loss (ml), amount of retransfused washed shed blood and amount of allogeneic and/or autologous transfusion (ml) were recorded.

Results

In both the cemented and non-cemented revision THA groups, there was no significant difference between pre- and post-operative Hb with or without using an autotransfusion system. In 92 of 186 cemented cases using an autologous transfusion system (49.5 %) and 38 of 117 non-cemented cases using an autologous transfusion system (32.5 %), allogeneic blood transfusion (ABT) was required. Cemented procedures using an autologous transfusion system got significantly more ABTs than non-cemented procedures using an autologous transfusion system (p = 0.0042, odds ratio = 2.035).

Conclusions

Use of an autologous transfusion system did not reduce the amount of ABT in revision THA in the patient cohort reported here. In our opinion, general blood management is required before and during surgery to reduce administration of ABT.     

Drain clamping in knee arthroplasty, a randomized controlled trial

BACKGROUND: The purpose of this study was to determine whether repeated clamping of a suction drainage system will result in less external blood loss, blood transfusion and no increase in complications compared to a routine continuous suction drainage system. This was a randomized prospective study on patients undergoing total knee arthroplasty. METHODS: Group A patients' drains were left clamped for all but 5 min (or 100 mL drainage) every 2 h for the first 6 h, then at 12-h and 24-h periods, when the drains were removed. Group B patients had continuous suction drainage. The amount of external blood loss, transfusion requirements and complications were compared between the two groups. The study group comprised 66 patients. RESULTS: The mean external blood loss in the clamped drain group was 296.67 mL (standard deviation 160.28 mL) with a mean drain in situ time of 32 h, significantly less (P < 0.05) than the continuous drain group that had a mean external blood loss of 796 mL (standard deviation 250.34 mL) with a mean drain in situ time of 34 h. There was no difference in the requirements for transfusion between the two groups. CONCLUSION: We conclude that clamping drains intermittently in hybrid total knee arthroplasty results in significantly less external blood loss with no change in morbidity or mortality. This study was a level 1 therapeutic study (i.e. with level of evidence randomized control trial with a significant difference).     

单侧全髋关节置换术围手术期总失血量的相关影响因素分析

目的 :探讨单侧人工全髋关节置换围术期总失血量的相关影响因素。方法 :搜集我院2014年1月至2016年7月行单侧人工全髋关节置换患者病例,共131例,男55例,女76例;年龄40~89岁,平均64.5岁。根据观测指标记录患者的一般资料、凝血功能指标、术前术后血红蛋白值和红细胞压积值变化情况,利用Gross方程计算出患者围术期失血量,采用统计学软件进行数据分析。结果:全髋关节置换后患者的实际失血量受发病因素、下肢深静脉血栓因素的影响(P0.05),而性别、年龄、体重指数、假体材料、麻醉方式对置换后失血量形成的影响不大。结论:全髋关节置换术实际失血的程度可以通过调整非手术因素(如性别、年龄、体重指数、假体材料、发病因素)和手术中的人为因素(术后并发症、麻醉方式等)得到控制。