切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 438 -449. doi: 10.3877/cma.j.issn.1674-134X.2021.04.008

荟萃分析

氨甲环酸不同使用方法在膝关节置换中的疗效分析
李浩1, 李亚坤1, 王浩浩1, 张民1,†()   
  1. 1. 030009　山西医科大学附属太原市中心医院
  • 收稿日期:2020-06-16 出版日期:2021-09-29
  • 通信作者: 张民

Effect analysis of different methods of tranexamic acid application in knee arthroplasty

Hao Li1, Yakun Li1, Haohao Wang1, Min Zhang1,†()   

  1. 1. Department of Orthopedics, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan 030009, China
  • Received:2020-06-16 Published:2021-09-29
  • Corresponding author: Min Zhang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李浩, 李亚坤, 王浩浩, 张民. 氨甲环酸不同使用方法在膝关节置换中的疗效分析[J]. 中华关节外科杂志(电子版), 2021, 15(04): 438-449.

Hao Li, Yakun Li, Haohao Wang, Min Zhang. Effect analysis of different methods of tranexamic acid application in knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(04): 438-449.

目的

比较关节腔注射、静脉滴注和联合二者应用氨甲环酸(TXA)对全膝关节置换(TKA)患者失血量和输血量的影响。

方法

通过计算机检索PubMed、Cochrane Library、荷兰医学文摘(Embase)等英文数据库和中国知网、万方、维普及中国生物医学等中文数据库，搜索氨甲环酸用于膝关节置换术的相关文献，纳入其中研究方法为随机对照的文献，并对文献进行质量评价，所提取数据使用软件StataV.15.1进行Meta分析。

结果

共纳入40项随机对照临床试验，共包括5 295例患者。Meta分析结果显示关节腔注射与静脉点滴氨甲环酸相比，在总失血量、术后引流量、术后血红蛋白水平、血红蛋白下降值、输血率及血栓事件发生率方面疗效相似，差异无统计学意义(P>0.05)；联合静脉滴注和关节腔注射与单一方案应用氨甲环酸相比，可显著减少总失血量[加权均数差(WMD)＝-116.39，95%置信区间(CI)(-149.26，-83.52)，P<0.05]，减少术后引流量[WMD＝-57.99，95% CI(-85.92，-30.06)，P＝0.005]，提高术后血红蛋白水平[标准化均数差(SMD)＝0.73，95%CI(0.49，0.98)，P＝0.001]，降低血红蛋白丢失量[SMD＝-0.66，95% CI(-1.06，-0.28)，P＝0.025]，降低输血率[相对危险度(RR)＝0.43，95% CI(0.30，0.61)，P<0.05]，而在血栓事件上两者差异没有统计学意义(P>0.05)。

结论

在全膝关节置换术中，推荐联合静脉滴注和关节腔局部注射应用氨甲环酸，可以明显改善临床结局。

关键词: 关节成形术, 置换, 膝, 氨甲环酸, 治疗结果, Meta分析
Objective

To compare the effects of intraarticular injection, intravenous drip and combined application of tranexamic acid (TXA) on blood loss and blood transfusion in patients undergoing total knee arthroplasty (TKA).

Methods

Through computer retrieval of English databases such as PubMed, Cochrane Library and Excerpta Medica Database(Embase) and Chinese databases such as China National Knowledge Infrastructure (CNKI), WanFang, VIP and Chinese BioMedical Literature Database (CBM), the relevant literature on the use of tranexamic acid in knee arthroplasty was searched. The literatures with randomized control methods were included, and the quality of the literatures was evaluated. The extracted data were analyzed by the software StataV.15.1.

Results

A total of 40 randomized controlled trials were included, including 5 295 patients. The results of meta analysis showed that compared with intravenous drip of tranexamic acid, intra-articular injection had similar effects on total blood loss, drainage volume, postoperative hemoglobin level, hemoglobin reduction, blood transfusion rate and incidence of thrombotic events, there was no significant difference (P>0.05). Compared with single regimen, combined intravenous and local application of TXA could significantly reduce total blood loss[weighted mean difference (WMD)=-116.39, 95% confidence interval (CI) (-149.26, -83.52), P<0.05], reduce postoperative drainage [WMD=-57.99, 95%CI (-85.92, -30.06), P=0.005], increase postoperative hemoglobin level [standardized mean difference (SMD)=0.73, 95%CI (0.49, 0.98), P=0.001], decrease hemoglobin loss[SMD=-0.66, 95%CI(-1.06, -0.28), P=0.025] and blood transfusion rate[relative risk (RR)=0.43, 95%CI(0.30, 0.61), P<0.05]. There was no statistically significant difference in thrombus events between the two groups(P>0.05).

Conclusion

It is recommended to use tranexamic acid locally and intravenously in total knee arthroplasty, which can significantly improve the clinical outcome.

Key words: Arthroplasty, replacement, knee, Tranexamic acid, Treatment outcome, Meta-analysis
表1 关节腔注射和静脉滴注TXA(氨甲环酸)基本情况
作者(年份) 样本量 年龄(岁) 性别(男/女) 手术方案 静脉滴注组 关节腔注射组 止血带使用 血栓预防方案
梁洪忠[30](2017) 80 70 (35/45) 单侧TKA 关闭切口前10 mg/kg 缝合关节囊后0.5 g 是 低分子肝素
宝音[22](2017) 60 66 (20/40) 单侧TKA 术前0.5 h 、20 mg/kg 缝合关节囊后1 g 是 利伐沙班
李华贵[28](2017) 80 67 (32/48) 单侧TKA 止血带充气前20 min、松止血带前15 min、术后3 h各10 mg/kg 缝合关节囊后3 g 是 利伐沙班
潘云春[32](2016) 140 67 (48/92) 单侧TKA 松止血带前30 min 20 mg/kg 松止血带前30 min 3 g 是 利伐沙班
柴星宇[23](2015) 90 71 (28/62) 单侧TKA 麻醉诱导期10 mg/kg 假体安装后2 g 是 利伐沙班
高智慧[26](2018) 100 64 (28/72) 单侧TKA 止血带充气前1 g +缝合关节囊后1 g 缝合关节囊后2 g 是 利伐沙班
杨伟臻[36](2016) 121 73 (40/81) 单侧TKA 切皮前10 min 10 mg/kg 缝合关节囊后1 g 是 低分子肝素
张岩[37](2019) 128 64 (52/76) 单侧TKA 止血带充气前1 g +止血带充气后1 g 假体安装后3 g 是 -
胡文浩[27](2018) 70 68 (13/57) 单侧TKA 切皮前1 g +缝合皮肤时1 g 缝合皮肤后2 g 是 低分子肝素
Chen[39](2016) 100 65 (25/75) 单侧TKA 麻醉诱导后30 min 1.5 g 假体安装后20 min 1.5 g 是 低分子肝素
Digas[40](2015) 60 71 (9/51) 单侧TKA 松止血带前15 mg/kg 关闭切口后2 g 是 亭扎肝素
Drosos[41](2016) 60 70 (12/48) 单侧TKA 缝合切口开始时1 g 缝合切口开始时1 g 是 -
George[42](2017) 113 64 (38/75) 单侧TKA 止血带充气前10 mg/kg+松止血带前10 mg/kg 关闭切口前1.5 g 是 依诺肝素
Barrena[43](2014) 78 71 (27/51) 单侧TKA 松止血带前20 min 15 mg/kg+术后3 h 15 mg/kg 松止血带前3 g 是 依诺肝素
Elysee[46](2019) 63 65 (23/40) 单侧TKA 止血带充气前2 g 松止血带前5 min 3 g 是 -
Lee[47](2017) 396 73 (50/346) 单侧TKA 松止血带前30 min 10 mg/kg +术后3 h 10 mg/kg 关闭切口前2 g 是 利伐沙班
Maniar[49](2012) 80 67 (16/64) 单侧TKA 松止血带前15 min 10 mg/kg 松止血带前5 min 3 g 是 低分子肝素
Abdel[38](2018) 640 66 (260/380) 单侧TKA 止血带充气前1 g 松止血带前3 g 是 阿司匹林
May[50](2016) 131 64 (29/102) 单侧TKA 麻醉诱导后2 g 关节囊缝合后2 g 是 低分子肝素
 Öztaş[52](2015) 60 68 (9/51) 单侧TKA 止血带充气前1 h 15 mg/kg+松止血带后1 h 10 mg/kg 关节囊缝合后2 g 是 依诺肝素
Patel[53](2014) 89 65 (23/66) 单侧TKA 松止血带前10 min 10 mg/kg 松止血带前2 min 2 g 是 低分子肝素
Sarzaeem[54](2014) 100 68 (13/87) 单侧TKA 切口关闭后1.5 g 切口关闭后1.5 g 是 -
Seo[55](2013) 100 67 (11/89) 单侧TKA 切口关闭后1.5 g 切口关闭后1.5 g 是 -
Song[56](2017) 100 69 (14/86) 单侧TKA 止血带充气前20 min +松止血带前15 min+第二次给药后3 h各10 mg/kg 切口闭合后1.5 g 是 低分子肝素
Subramanyam[57](2018) 182 63 (66/116) 单侧TKA 止血带充气前10 min 10 mg/kg+松止血带前10 min 10 mg/kg 切口关闭后1.5 g 是 阿司匹林
Tzatzairis[58](2016) 80 69 (16/64) 单侧TKA 麻醉诱导时1 g 关节囊缝合后1 g 否 低分子肝素
表2 联合应用和单一给药方案应用TXA(氨甲环酸)组基本情况
作者(年份) 样本量 年龄(岁) 性别(男/女) 手术方案 联合使用组 单一使用组 止血带使用 血栓预防方案
褚国庆[24](2018) 100 68 (40/58) 单侧TKA 切皮前15 min静脉1 g+松止血带前关节腔1 g 切皮前15 min静脉1 g 是 -
李辉[29](2017) 122 66 (24/98) 单侧TKA 松止血带前15 min静脉1 g+松止血带前2 min关节腔1 g 松止血带前2 min关节腔2 g 是 利伐沙班
孙博[33](2019) 100 68 (56/44) 单侧TKA 松止血带前静脉20 mg/kg+关节腔3 g 松止血带前关节腔3 g 是 -
王庆东[34](2016) 64 67 (12/52) 单侧TKA 止血带充气前10 min静脉1 g+缝合关节囊后关节腔2 g 缝合关节囊后关节腔2 g 是 低分子肝素
罗太行[31](2018) 60 64 (29/31) 单侧TKA 切皮前1 h静脉500 mg+缝合切口前静脉500 mg+缝合切口前关节腔0.5 g 切皮前1 h静脉500 mg+缝合切口前静脉500 mg 是 低分子肝素
段虹昊[25](2017) 187 66 (27/160) 单侧TKA 松止血带前20 min静脉1 g+缝合关节囊后关节腔1 g 松止血带前20 min静脉1 g+给药3 h后静脉1 g 是 利伐沙班
武辉[35](2018) 86 63 (41/45) 单侧TKA 松止血带前20 min静脉10 mg/kg+术后关节腔1 g 术后关节腔1 g 是 利伐沙班
Huang[44](2014) 184 65 (67/117) 单侧TKA 止血带充气前静脉1.5 g+假体安装后关节腔1.5 g 止血带充气前静脉3 g 是 低分子肝素
Jain[45](2016) 119 69 (44/75) 单侧TKA 切皮前30 min静脉1.5 g+切口关闭后关节腔1.5 g 切皮前30 min静脉3 g 是 低分子肝素
Lee[47](2017) 396 73 (50/346) 单侧TKA 低剂量组：止血带充气前30 min和术后3 h各静脉10 mg/kg+关节囊缝合后关节腔1 g 止血带充气前30 min和术后3 h各静脉10 mg/kg
关节囊缝合后关节腔2 g		 是 利伐沙班
高剂量组：止血带充气前30 min和术后3 h各静脉10 mg/kg+关节囊缝合后关节腔2 g
Lin[48](2015) 120 71 (22/98) 单侧TKA 切皮前15 min静脉1 g+关节囊缝合后关节腔1 g 关节囊缝合后关节腔1 g 是 利伐沙班
Nielsen[51](2016) 60 64 (28/32) 单侧TKA 麻醉诱导时静脉1 g+关节囊缝合后关节腔3 g 麻醉诱导时静脉1 g 否 利伐沙班
Song[56](2017) 150 69 (21/129) 单侧TKA 术前和术后各静脉10 mg/kg+切口闭合后关节腔1.5 g 止血带充气前20 min+松止血带前15 min+第二次给药后3 h各静脉10 mg/kg 是 低分子肝素
图1 文献筛选流程图
图2 纳入的各项研究的方法学偏倚
图3 所有研究对于每一项评价内容的偏倚情况
图4 静脉滴注与关节腔注射TXA(氨甲环酸)总失血量森林图
图5 静脉滴注与关节腔注射TXA(氨甲环酸)术后引流量森林图
图6 静脉滴注与关节腔注射TXA(氨甲环酸)术后血红蛋白水平森林图
图7 静脉滴注与关节腔注射TXA(氨甲环酸)血红蛋白下降程度森林图
图8 静脉滴注与关节腔注射TXA(氨甲环酸)术后输血率森林图
图9 静脉滴注与关节腔注射TXA(氨甲环酸)血栓事件发生率森林图
图10 联合应用和单一给药方案应用TXA(氨甲环酸)总失血量森林图
图11 联合应用和单一给药方案应用TXA(氨甲环酸)术后引流量森林图
图12 联合应用和单一给药方案应用TXA(氨甲环酸)术后血红蛋白水平森林图
图13 联合应用和单一给药方案应用TXA(氨甲环酸)血红蛋白下降程度森林图
图14 联合应用和单一给药方案应用TXA(氨甲环酸)术后输血率森林图
图15 联合应用和单一给药方案应用TXA(氨甲环酸)血栓事件发生率森林图
[1]
Ethgen O, Bruyère O, Richy F, et al. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature[J]. J Bone Joint Surg Am, 2004, 86-A(5): 963-974.
[2]
Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030[J]. J Bone Joint Surg Am, 2007, 89(4): 780-785.
[3]
Wong J, Abrishami A, El Beheiry H, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial[J]. J Bone Joint Surg Am, 2010, 92(15): 2503-2513.
[4]
Sculco TP, Baldini A, Keating EM. Blood management in total joint arthroplasty[J]. Instr Course Lect, 2005, 54: 51-66.
[5]
Rasouli MR, Maltenfort MG, Erkocak OF, et al. Blood management after total joint arthroplasty in the United States：19-year trend analysis[J]. Transfusion, 2016, 56(5): 1112-1120.
[6]
Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, et al. Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement: a double-blind, randomized, controlled, noninferiority clinical trial[J]. J Bone Joint Surg Am, 2014, 96(23): 1937-1944.
[7]
Dunn CJ, Goa KL. Tranexamic acid：a review of its use in surgery and other indications[J]. Drugs, 1999, 57(6): 1005-1032.
[8]
Samujh C, Falls TD, Wessel R, et al. Decreased blood transfusion following revision total knee arthroplasty using tranexamic acid[J]. J Arthroplasty, 2014, 29(9, S): 182-185.
[9]
Henry DA, Moxey AJ, Carless PA, et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion[J/OL]. Cochrane Database Syst Rev, 2011 (3): CD001886. doi：10.1002/14651858.CD001886.pub4.
[10]
Ker K, Prieto-Merino D, Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss[J]. Br J Surg, 2013, 100(10): 1271-1279.
[11]
CRASH-2 collaborators, Roberts I, Shakur H, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial[J]. Lancet, 2011, 377(9771): 1096-1101, 1101.e1-e2.
[12]
Simonazzi G, Bisulli M, Saccone G, et al. Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials[J]. Acta Obstet Gynecol Scand, 2016, 95(1): 28-37.
[13]
Adler MS, Brindle W, Burton G, et al. Tranexamic acid is associated with less blood transfusion in off-pump coronary artery bypass graft surgery: a systematic review and meta-analysis[J]. J Cardiothorac Vasc Anesth, 2011, 25(1): 26-35.
[14]
Benoni G, Carlsson A, Petersson C, et al. Does tranexamic acid reduce blood loss in knee arthroplasty？[J]. Am J Knee Surg, 1995, 8(3): 88-92.
[15]
Ishida K, Tsumura N, Kitagawa A, et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty[J]. Int Orthop, 2011, 35(11): 1639-1645.
[16]
Yue C, Pei F, Yang P, et al. Effect of topical tranexamic acid in reducing bleeding and transfusions in TKA[J]. Orthopedics, 2015, 38(5): 315-324.
[17]
Gao F, Ma J, Sun W, et al. Topical fibrin sealant versus intravenous tranexamic acid for reducing blood loss following total knee arthroplasty: a systematic review and meta-analysis[J]. Int J Surg, 2016, 32: 31-37.
[18]
Liu Q, Geng P, Shi L, et al. Tranexamic acid versus aminocaproic acid for blood management after total knee and total hip arthroplasty: a systematic review and meta-analysis[J]. Int J Surg, 2018, 54(Pt A): 105-112.
[19]
Higgins JT. Measuring inconsistency in meta-analyses[J]. BMJ, 2003, 327(7414): 557-560.
[20]
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias[J]. Biometrics, 1994, 50(4): 1088-1101.
[21]
Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test[J]. BMJ, 1997, 315(719): 629-634.
[22]
宝音，王嘎日迪，李晓东．氨甲环酸不同给药途径对膝关节置换失血量的影响[J]．中国矫形外科杂志，2017，25(12)：1096-1101.
[23]
柴星宇，苏长征，庞涛，等．全膝关节置换后静脉与局部应用氨甲环酸对失血量的影响[J]．中国组织工程研究，2015，19(35)：5604-5609.
[24]
褚国庆，刘藜箬，闫明童，等．氨甲环酸静脉联合局部用药减少初次单侧膝关节置换出血[J/CD]．中华关节外科杂志(电子版)，2018，12(5)：671-675.
[25]
段虹昊，马建兵，李辉，等．全膝关节置换术中氨甲环酸不同用法的疗效与安全性研究[J]．实用骨科杂志，2017，23(1)：5-8.
[26]
高智慧，张帅，郭浩辉，等．关节腔内注射及静脉滴注氨甲环酸对全膝关节置换术后失血的影响[J]．临床骨科杂志，2018，21(1)：59-61.
[27]
胡文浩．静脉与局部应用氨甲环酸在初次全膝关节置换中的比较[J]．中国组织工程研究，2018，22(3)：356-361.
[28]
李华贵，常炳营，王伟，等．静脉及关节腔内注射氨甲环酸减少全膝关节置换术后出血的对比研究[J]．中国现代医学杂志，2017，27(22)：117-120.
[29]
李辉，马建兵，姚舒馨，等．氨甲环酸应用于全膝关节置换术围术期的给药方式比较[J]．中华骨与关节外科杂志，2017，10(1)：37-40.
[30]
梁洪忠，朱延民．氨甲环酸不同给药方式对全膝关节置换术术后失血量和凝血功能的影响[J]．医学综述，2017，23(2)：414-417.
[31]
罗太行，古霖，罗世富．联合应用氨甲环酸对TKA术后失血量疗效观察[J]．养生保健指南，2018，16(19)：314-315.
[32]
潘云春，卢菁，张其亮．静脉及局部应用氨甲环酸对全膝关节置换围术期失血的影响[J]．中国医药导报，2016，13(12)：156-159.
[33]
孙博，王静悦，李冀．氨甲环酸静脉与局部联合用药对全膝关节置换患者围术期纤溶活性与失血量的影响[J]．河北医学，2019，25(3)：667-671.
[34]
王庆东，李付彬，徐向峰，等．氨甲环酸术前静脉滴注联合术中关节内注射对全膝关节置换术围手术期失血量的影响[J]．中医正骨，2016，28(1)：24-27.
[35]
武辉，全健，雷斌．关节腔和静脉联合应用氨甲环酸对人工全膝关节置换术疗效及出血量的影响[J]．安徽医药，2018，22(10)：1983-1986.
[36]
杨伟臻，张剑锋，胡宝德，等．静脉与关节腔内应用氨甲环酸减少全膝关节置换失血量的疗效对比[J]．中国医学创新，2016，13(27)：1-5.
[37]
张岩，阚泉，张军伟，等．重度膝骨关节炎患者全膝关节置换术中氨甲环酸静脉注射与关节腔内注射的止血效果对比观察[J]．山东医药，2019，59(21)：58-60.
[38]
Abdel MP, Chalmerset BP, Tauntonal MJ, et al. Intravenous versus topical tranexamic acid in total knee arthroplasty：both effective in a randomized clinical trial of 640 patients[J]. J Bone Joint Surg Am, 2018, 100(12): 1023-1029.
[39]
Jy C, Chin PL, Moo IH, et al. Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: a double-blinded randomised controlled noninferiority trial[J]. Knee, 2016, 23(1): 152-156.
[40]
Digas G, Koutsogiannis I, Meletiadis G, et al. Intra-articular injection of tranexamic acid reduce blood loss in cemented total knee arthroplasty[J]. Eur J Orthop Surg Traumatol, 2015, 25(7): 1181-1188.
[41]
Drosos GI, Ververidis A, Valkanis C, et al. A randomized comparative study of topical versus intravenous tranexamic acid administration in enhanced recovery after surgery (ERAS) total knee replacement[J]. J Orthop, 2016, 13(3): 127-131.
[42]
George J, Eachempati KK, Subramanyam KN, et al. The comparative efficacy and safety of topical and intravenous tranexamic acid for reducing perioperative blood loss in total knee arthroplasty- a randomized controlled non-inferiority trial[J]. Knee, 2018, 25(1): 185-191.
[43]
Gomez-Barrenae G, Ortega-Andreu M, Padilla-Eguiluz NG, et al. Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement：a double-blind, randomized, controlled, noninferiority clinical trial[J]. J Bone Joint Surg Am, 2014, 96(23): 1937-1944.
[44]
Huang Z, Ma J, Shen B, et al. Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty: a prospective randomized controlled trial[J]. J Arthroplasty, 2014, 29(12): 2342-2346.
[45]
Jain NP, Nisthane PP, Shah NA. Combined administration of systemic and topical tranexamic acid for total knee arthroplasty: can it be a better regimen and yet safe? A randomized controlled trial[J]. J Arthroplasty, 2016, 31(2): 542-547.
[46]
Jules-Elyseekm J, Tseng A, Sculco TP, et al. Comparison of topical and intravenous tranexamic acid for total knee replacement：a randomized double-blinded controlled study of effects on tranexamic acid levels and thrombogenic and inflammatory marker levels[J]. J Bone Joint Surg Am, 2019, 101(23): 2120-2128.
[47]
Lee SY, Chong S, Balasubramanian D, et al. What is the ideal route of administration of tranexamic acid in TKA? A randomized controlled trial[J]. Clin Orthop Relat Res, 2017, 475(8): 1987-1996.
[48]
Lin SY, Chen CH, Fu YC, et al. The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty[J]. J Arthroplasty, 2015, 30(5): 776-780.
[49]
Maniar RN, Kumar G, Singhi T, et al. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients[J]. Clin Orthop Relat Res, 2012, 470(9): 2605-2612.
[50]
May JH, Rieser GR, Williams CG, et al. The assessment of blood loss during total knee arthroplasty when comparing intravenous vs intracapsular administration of tranexamic acid[J]. J Arthroplasty, 2016, 31(11): 2452-2457.
[51]
Nielsen CS, Jans Ø, Ørsnes T, et al. Combined intra-articular and intravenous tranexamic acid reduces blood loss in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial[J]. J Bone Joint Surg Am, 2016, 98(10): 835-841.
[52]
Özta S, Öztürk A, Akalin Y, et al. The effect of local and systemic application of tranexamic acid on the amount of blood loss and allogeneic blood transfusion after total knee replacement[J]. Acta Orthop Belg, 2015, 81(4): 698-707.
[53]
Patel JN, Spanyer JM, Smith LS, et al. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study[J]. J Arthroplasty, 2014, 29(8): 1528-1531.
[54]
Sarzaeem MM, Razi M, Kazemian G, et al. Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty[J]. J Arthroplasty, 2014, 29(8): 1521-1524.
[55]
Seo JG, Moon YW, Park SH, et al. The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(8): 1869-1874.
[56]
Song EK, Seon JK, Prakash J, et al. Combined administration of IV and topical tranexamic acid is not superior to either individually in primary navigated TKA[J]. J Arthroplasty, 2017, 32(1): 37-42.
[57]
Subramanyam KN, Khanchandani P, Tulajaprasad PV, et al. Efficacy and safety of intra-articular versus intravenous tranexamic acid in reducing perioperative blood loss in total knee arthroplasty: a prospective randomized double-blind equivalence trial[J]. Bone Joint J, 2018, 100-B(2): 152-160.
[58]
Tzatzairis TK, Drosos GI, Kotsios SE, et al. Intravenous vs topical tranexamic acid in total knee arthroplasty without tourniquet application: a randomized controlled study[J]. J Arthroplasty, 2016, 31(11): 2465-2470.
[59]
Uğurlu M, Aksekili MA, Çăglar C, et al. Effect of topical and intravenously applied tranexamic acid compared to control group on bleeding in primary unilateral total knee arthroplasty[J]. J Knee Surg, 2017, 30(2): 152-157.
[60]
Wang J, Wang Q, Zhang X, et al. Intra-articular application is more effective than intravenous application of tranexamic acid in total knee arthroplasty: a prospective randomized controlled trial[J]. J Arthroplasty, 2017, 32(11): 3385-3389
[61]
Wei W, Dang S, Duan D, et al. Comparison of intravenous and topical tranexamic acid in total knee arthroplasty[J/OL]. BMC Musculoskelet Disord, 2018, 19(1): 191. doi：10.1186/s12891-018-2122-7.
[62]
Hiippala ST, Strid LJ, Wennerstrand MI, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty[J]. Anesth Analg, 1997, 84(4): 839-844.
[63]
Xie J, Hu Q, Huang Q, et al. Comparison of intravenous versus topical tranexamic acid in primary total hip and knee arthroplasty: an updated meta-analysis[J]. Thromb Res, 2017, 153: 28-36.
[64]
Panteli M, Papakostidis C, Dahabreh Z, et al. Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis[J]. Knee, 2013, 20(5): 300-309.
[65]
Andersson L, Nilsson IM, Niléhn JE, et al. Experimental and clinical studies on AMCA, the antifibrinolytically active isomer of p-aminomethyl cyclohexane carboxylic acid[J]. Scand J Haematol, 1965, 2(3): 230-247.
[66]
Sukeik M, Alshryda S, Haddad FS, et al. Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement[J]. J Bone Joint Surg Br, 2011, 93B(1): 39-46.
[67]
Aglietti P, Baldini A, Vena LM, et al. Effect of tourniquet use on activation of coagulation in total knee replacement[J]. Clin Orthop Relat Res, 2000, (371): 169-177.
[68]
Sun X, Dong Q, Zhang YG. Intravenous versus topical tranexamic acid in primary total hip replacement: a systemic review and meta-analysis[J]. Int J Surg, 2016, 32: 10-18.
[69]
Benoni G, Fredin H, Knebel R, et al. Blood conservation with tranexamic acid in total hip arthroplasty - a randomized, double-blind study in 40 primary operations[J]. Acta Orthop Scand, 2001, 72(5): 442-448.
[1] 林文, 王雨萱, 许嘉悦, 王矜群, 王睿娜, 何董源, 樊沛. 人工关节置换登记系统的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 834-841.
[2] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[3] 黄子荣, 罗渝鑫, 杨文瀚, 陈小虎, 谢环宇, 朱伟民. 前交叉韧带重建对膝关节稳定性影响的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 847-854.
[4] 樊绪国, 赵永刚, 杨砚伟. 腓骨在膝骨关节炎作用的研究观点[J]. 中华关节外科杂志(电子版), 2023, 17(06): 855-859.
[5] 贺敬龙, 尚宏喜, 郝敏, 谢伟, 高明宏, 孙炜, 刘安庆. 重度类风湿关节炎患者行多关节置换术的临床手术疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 860-864.
[6] 孟繁宇, 周新社, 赵志, 裴立家, 刘犇. 侧位直接前方入路髋关节置换治疗偏瘫肢体股骨颈骨折[J]. 中华关节外科杂志(电子版), 2023, 17(06): 865-870.
[7] 王宏宇. 固定与活动平台假体在全膝关节置换术中的应用价值[J]. 中华关节外科杂志(电子版), 2023, 17(06): 871-876.
[8] 夏传龙, 迟健, 丛强, 连杰, 崔峻, 陈彦玲. 富血小板血浆联合关节镜治疗半月板损伤的临床疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 877-881.
[9] 陈山林, 魏绮珮, 刘畅. 腕关节假体：路在何方？[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 469-475.
[10] 吴香敏, 吴鹏. 超声引导下收肌管阻滞联合腘动脉与膝关节后囊间隙阻滞在老年患者全膝关节置换术中的应用效果[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 516-522.
[11] 陈垚, 徐伯群, 高志慧. 改良式中间上入路根治术治疗甲状腺癌的有效性安全性研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 619-622.
[12] 中华医学会骨科分会关节学组. 中国髋、膝关节置换日间手术围手术期管理专家共识[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 321-332.
[13] 邱红生, 林树体, 梁朝莹, 劳世高, 何荷. 模拟现实步态训练对膝关节前交叉韧带损伤的功能恢复及对跌倒恐惧的影响[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 343-350.
[14] 付庆鹏, 邓晓强, 高伟, 姜福民, 范永峰, 吴海贺, 齐岩松, 包呼日查, 徐永胜. 新型股骨测量定位器在全膝关节置换术中的临床应用[J]. 中华临床医师杂志(电子版), 2023, 17(9): 980-987.
[15] 李岩松, 李涛, 张元鸣飞, 李志鹏, 周谋望. 头戴式虚拟现实设备辅助全膝关节置换术后康复的初步研究[J]. 中华临床医师杂志(电子版), 2023, 17(06): 676-681.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号