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中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 273 -277. doi: 10.3877/cma.j.issn.1674-134X.2022.03.003

临床论著

全膝关节置换术中氨甲环酸联合罗哌卡因骨膜下注射效果
林涌生1,†(), 林志斌1, 李扬1, 陈宏1, 陈松亮1   
  1. 1. 522000　广东省揭阳市人民医院骨外一科
  • 收稿日期:2021-03-23 出版日期:2022-06-01
  • 通信作者: 林涌生
  • 基金资助:
    广东省揭阳市科技计划项目(ylxm072)

Effects of subperiosteal injection of tranexamic acid combined with ropivacaine in total knee arthroplasty

Yongsheng Lin1,†(), Zhibin Lin1, Yang Li1, Hong Chen1, Songliang Chen1   

  1. 1. The No.1 Department of Orthopedics, Jieyang People's Hospital, Jieyang 522000, China
  • Received:2021-03-23 Published:2022-06-01
  • Corresponding author: Yongsheng Lin
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林涌生, 林志斌, 李扬, 陈宏, 陈松亮. 全膝关节置换术中氨甲环酸联合罗哌卡因骨膜下注射效果[J]. 中华关节外科杂志(电子版), 2022, 16(03): 273-277.

Yongsheng Lin, Zhibin Lin, Yang Li, Hong Chen, Songliang Chen. Effects of subperiosteal injection of tranexamic acid combined with ropivacaine in total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(03): 273-277.

目的

探讨骨膜下注射氨甲环酸(TXA)联合罗哌卡因在单侧全膝关节置换术(TKA)中应用的疗效。

方法

回顾性对比分析2017年1月至2021年1月于广东省揭阳市人民医院骨外一科行初次单侧TKA的154例重度膝关节骨关节炎患者(病例纳入标准为年龄在60~80岁的仅行单侧TKA手术的膝关节重度骨关节炎患者；排除标准为TXA或罗哌卡因药物过敏、血液指标异常或者相关数据缺失的患者),分为2组。其中TKA术中采用关节腔周围注射1 g TXA以及100 mg罗哌卡因的共80例(传统组)，采用股骨远端与胫骨近端骨膜下注射1 g TXA以及100 mg罗哌卡因的患者74例(改良组)，比较两组患者的术中失血量、总失血量、术后3 d血红蛋白(Hb)下降值、术后1、2、3、7以及14 d的视觉模拟评分(VAS)、术后并发症发生率、手术时间和住院时间等指标。采用t检验和卡方检验等行统计分析。

结果

154例患者术后均未出现明显并发症。两组患者一般情况、术前血红蛋白、术前VAS评分、手术时间以及住院时间结果差异无统计学意义(均为P>0.05)。两组术中出血量差异无统计学意义(P>0.05)；改良组总失血量(t＝5.476)、术后3 d的Hb下降值(t＝3.705)低于传统组(均为P<0.05)。术后不同时间(1、2、3、7和14 d)不同状态下疼痛VAS评分比较发现，改良组的术后VAS评分在膝关节静息状态(F＝13.512)和屈曲状态(F＝18.185)均比传统组更小(均为P<0.001)。

结论

骨膜下注射TXA及罗哌卡因可有效减少TKA手术失血量，并明显减轻术后早期疼痛。

关键词: 关节成形术，置换，膝, 氨甲环酸, 罗哌卡因, 骨膜
Objective

To investigate the effect of subperiosteal injection of tranexamic acid (TXA) combined with ropivacaine in unilateral total knee arthroplasty (TKA).

Methods

A retrospective analysis was carried out on 154 patients with severe knee osteoarthritis who underwent unilateral TKA in the No.1 Department of Orthopaedic Surgery, Jieyang People's Hospital from January 2017 to January 2021. Inclusion criteria: age from 60 to 80 years with severe knee osteoarthritis, undergoing unilateral TKA only; exclusion criteria: allergy to TXA or ropivacaine, abnormal blood parameters, or data missing. The patients were divided into two groups. Among them, 80 patients were injected with one gram TXA and 100 mg ropivacaine around the joint cavity during TKA operation (the traditional group), and subperiosteal injection of one gram TXA and 100 mg ropivacaine was applied at the distal femur and proximal tibia in 74 patients (the modified group). The intraoperative blood loss, total blood loss, hemoglobin (Hb) decreasing in three days after surgery, the visual analogue score (VAS) on one, two, three, seven, and 14 days after the surgery, the incidence of postoperative complications, operation time, and hospitalization time were compared between the two groups. Statistical analysis was performed using t test and chi square test.

Results

No obvious complication occurred in 154 patients. There was no statistically significant difference in the general condition, preoperative Hb, preoperative VAS score, operation time, or hospitalization time between the two groups (all P>0.05). The amounts of blood loss of the two groups showed no statistically significant difference (P>0.05); the total blood loss (t=5.476, P<0.05) and the decrease of Hb three days after the operation (t=3.705, P<0.05) in the modified group were lower than those in the traditional group. The repeated measures ANOVA on the VAS scores in the resting state and joint flexion state of two groups on one, two, three, seven, and 14 days showed that the modified group reported less postoperative pain than the conventional group both at rest (F=13.512, P<0.001) and in knee flexion (F=18.185, P<0.001).

Conclusion

Subperiosteal injection of TXA and ropivacaine can effectively reduce blood loss during TKA surgery and significantly reduce early postoperative pain.

Key words: Arthroplasty, replacement, knee, Tranexamic acid, Ropivacaine, Periosteum
图2 传统组在关节周围软组织中注射氨甲环酸和罗哌卡因
表1 两组患者的一般资料比较
项目 传统组 改良组 统计值 P值
例数 80 74    
性别(男/女) 27/53 24/50 χ2＝0.030 >0.05
年龄[岁，(±s)] 70.8±8.0 71.5±8.0 t＝0.535 >0.05
BMI[kg/m2，(±s)] 24.1±1.7 23.9±1.8 t＝0.461 >0.05
手术时间[min，(±s)] 64.5±9.0 64.13±8.9 t＝0.271 >0.05
住院天数[d，(±s)] 7.0±1.4 6.9±1.5 t＝0.376 >0.05
术前Hb[g/L，(±s)] 129.0±11.0 131.6±11.2 t＝1.442 >0.05
术前Hct[%，(±s)] 40.3±2.3 40.6±2.7 t＝0.728 >0.05
术前VAS得分(±s) 7.1±1.4 7.3±1.4 t＝0.573 >0.05
表2 两组患者全膝关节置换术后出血情况的比较(±s)
组别 例数 术中出血量(ml) 总失血量(ml) 血红蛋白下降值(g/L)
传统组 80 72±16 532±105 20±6
改良组 74 73±19 629±116 17±6
t值   0.438 5.476 3.705
P值   >0.05 <0.001 <0.001
表3 两组患者全膝关节置换术后关节静息状态下VAS评分的比较(±s)
组别 例数 术后1 d 术后2 d 术后3 d 术后7 d 术后14 d
传统组 80 6.1±1.2 6.1±1.1 5.8±1.0 3.3±1.2 2.3±0.8
改良组 74 5.7±1.3 5.6±1.2 5.1±1.1 3.2±1.1 2.2±0.9
F值   13.512
P值   <0.001
表4 两组患者全膝关节置换术后关节屈曲状态下VAS评分的比较(±s)
组别 例数 术后1 d 术后2 d 术后3 d 术后7 d 术后14 d
传统组 80 6.6±1.1 6.3±1.3 6.1±1.3 4.0±1.0 2.7±0.8
改良组 74 6.0±1.3 5.9±1.0 5.4±1.2 3.9±0.9 2.6±1.0
F值   18.185
P值   <0.001
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