直接前入路全髋关节置换术应用氨甲环酸的有效性及安全性

目的：评估局部应用氨甲环酸（tranexamic acid，TXA）降低直接前入路（direct anterior approach，DAA）全髋关节置换术围手术期失血量的有效性和安全性。方法：自2013年7月至2018年9月，采用直接前入路初次全髋关节置换治疗的46例股骨头坏死患者，分为氨甲环酸组和生理盐水组，各23例。其中，氨甲环酸组中男14例，女9例，年龄52~72（63.70±5.34）岁，采用氨甲环酸3 g稀释于50 ml生理盐水中，在假体置换完毕后关节腔浸泡3 min；生理盐水组中男13例，女10例，年龄55~73（61.26±5.78）岁，采用等量生理盐水，相同方法关节腔浸泡。比较两组患者的失血量、血红蛋白值、输血例数、术后首次下地时间、血栓以及切口不良事件的发生率，术后1、3个月采用Harris评分评价髋关节功能。结果：术后患者切口愈合良好，两组无明显并发症发生。46例患者获随访，时间12~59个月，平均31.11个月。随访患者无髋部疼痛，髋关节功能有效改善，均未出现假体松动。术后氨甲环酸组和生理盐水组围手术期总失血量分别为（740.09±77.14）、（1 069.07±113.53）ml，术后24 h引流量为（87.61±9.28）、（233.83±25.62）ml，隐性失血量为（409.65±38.01）、（588.33±57.16）ml，手术前后血红蛋白差值为（24.78±2.19）、（33.57±2.95）g/L，差异有统计学意义（P<0.05）。两组术中失血量、深静脉血栓及肺栓塞的发生率、术后髋关节Harris评分比较差异无统计学意义（P>0.05）。。结论：直接前入路全髋关节置换术中局部应用氨甲环酸可安全、有效地减少围手术期失血量，且不增加血栓形成的风险，不影响关节功能正常恢复。

Efficacy and safety of tranexamic acid in total hip arthroplasty via direct anterior approach

Objective: To evaluate the efficacy and safety of local application of tranexamic acid (TXA) in reducing perioperative blood loss in total hip arthroplasty via direct anterior approach (DAA). Methods: From July 2013 to September 2018,46 patients with avascular necrosis of the femoral head were divided into tranexamic acid group (n=23) and saline group (n=23). In the tranexamic acid group,there were 14 males and 9 females,aged 52 to 72(63.70±5.34) years old. They were diluted with 3 g tranexamic acid in 50 ml normal saline and immersed in the joint cavity for 3 min after prosthesis replacement;in the normal saline group,there were 13 males and 10 females,aged 55 to 73 (61.26±5.78) years,who were treated with the same amount of normal saline. The blood loss,hemoglobin value,number of blood transfusion cases,the time of first landing after operation,the incidence of thrombosis and incision adverse events were compared between the two groups. Harris score was used to evaluate hip joint function at 1 and 3 months after operation. Results: The incision healed well and no obvious complications occurred in the two groups. All patients were followed up for 12 to 59 months(averaged 31.11 months). No hip pain was found in the follow-up patients. Hip joint function was improved effectively and no prosthesis loosening occurred. The total perioperative blood loss in tranexamic acid group and normal saline group was(740.09±77.14) ml and (1 069.07±113.53) ml respectively,24 hours after operation,the drainage volume was (87.61±9.28) ml,(233.83±25.62) ml,the hidden blood loss was (409.65±38.01) ml and (588.33±57.16) ml. the difference of hemoglobin before and after operation was (24.78±2.19) g/L and (33.57±2.95) g/L,the difference was statistically significant (P<0.05). There was no significant difference in blood loss,incidence of deep vein thrombosis and pulmonary embolism,and Harris score of hip joint between the two groups(P>0.05). Conclusion: local application of tranexamic acid in total hip arthroplasty through direct anterior approach can safely and effectively reduce perioperative blood loss,and does not increase the risk of thrombosis,and does not affect the normal recovery of joint function.