目的:全髋关节置换术(THA)可有效治疗终末期血友病性髋关节病。鉴于血友病的独特特征,围手术期出血仍然是THA患者的重大风险.氨甲环酸(TXA),一种有效的抗纤维蛋白溶解剂,可能有利于血友病(PWH)患者的THA结果。本研究旨在探讨关节腔内注射TXA治疗PWH围手术期出血的临床疗效,并评估其额外的临床获益。
方法:回顾性研究包括2015年1月至2021年12月在研究中心接受THA的PWH数据。共有59人被纳入研究,分为TXA组(n=31)和非TXA组(n=28)。我们比较了各种参数,包括总失血量(TBL),可见失血(VBL),隐匿性失血(OBL),术中凝血因子VIII(FVIII)消耗,围手术期FVIII总消耗量,血红蛋白(HB),红细胞沉降率(ESR),C反应蛋白(CRP),住院时间,住院费用,手术长度,总蛋白质,活化部分凝血活酶时间(APTT),D-二聚体,关节肿胀率,髋关节活动范围(ROM),视觉模拟量表(VAS),两组患者Harris髋关节功能量表(HHS)评分。随访评估持续24个月。采用Studentt检验进行统计分析。
结果:这项研究表明,关节内TXA可有效降低TBL(1248.19±439.88mL,p<0.001),VBL(490.32±344.34mL,p=0.003),和OBL(757.87±381.48mL,p=0.004)在接受THA的PWH中。TXA在降低POD1,POD7和POD14的VAS评分以及POD1,POD7,POD14和出院时的关节肿胀率方面显示出有效性(p<0.05)。此外,TXA组在所有随访时间点都获得了更高的HHS评分(p<0.05),表现出优越的髋关节活动度,术后炎症水平较低,在手术过程中减少因子VIII的消耗,术后营养损失较少。两组住院时间无统计学差异,住院费用,手术持续时间,和凝血指标。
结论:关节内注射TXA减少了接受THA的PWH围手术期出血,同时还改善了关节活动度,术后康复,和生活质量。这可以为PWH中TXA的未来应用提供价值。
OBJECTIVE: Total hip arthroplasty (THA) effectively treats end-stage hemophilic hip arthropathy. Given
hemophilia\'s unique characteristics, perioperative bleeding remains a significant risk for patients undergoing THA. Tranexamic acid (TXA), an efficient antifibrinolytic agent, may benefit the outcomes of THA for patients with
hemophilia (PWH). This study aims to explore the clinical efficacy of intra-articular injection of TXA in treating perioperative bleeding in PWH and assess its additional clinical benefits.
METHODS: The retrospective study comprised data of PWH who received THA from January 2015 to December 2021 in the research center. A total of 59 individuals were included in the study, divided into a TXA group (n = 31) and a non-TXA group (n = 28). We compared various parameters, including total blood loss (TBL), visible blood loss (VBL), occult blood loss (OBL), intraoperative coagulation factor VIII (FVIII) consumption, perioperative total FVIII consumption, hemoglobin (HB), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), length of hospital stay, hospitalization costs, length of surgery, total protein, activated partial thromboplastin time (APTT), D-dimer, rate of joint swelling, hip joint range of motion (ROM), visual analogue scale (VAS), and Harris hip joint function scale (HHS) between the two groups. Follow-up assessments were conducted for up to 24 months. A Student\'s t test was utilized for the statistical analysis.
RESULTS: This study demonstrated that intra-articular TXA effectively reduced TBL (1248.19 ± 439.88 mL, p < 0.001), VBL (490.32 ± 344.34 mL, p = 0.003), and OBL (757.87 ± 381.48 mL, p = 0.004) in PWH who underwent THA. TXA demonstrated effectiveness in reducing VAS scores on POD1, POD7, and POD14 and joint swelling rates on POD1, POD7, POD14, and at discharge (p < 0.05). Additionally, the TXA group achieved higher HHS ratings at all follow-up time points (p < 0.05), showing superior hip joint mobility, lower postoperative inflammation levels, reduced factor VIII consumption during surgery, and less postoperative nutritional loss. No statistically significant differences were observed between the two groups in terms of hospital stay, hospitalization costs, surgery duration, and coagulation indicators.
CONCLUSIONS: Intra-articular injection of TXA reduces perioperative bleeding in PWH undergoing THA while also improving joint mobility, post-operative rehabilitation, and quality of life. This may provide value for the future application of TXA in PWH.