赵士清,郭青,孙权,张方
ZHAO Shiqing,GUO Qing,SUN Quan,ZHANG Fang

• 1:北京语言大学医院
• 2:沈阳药科大学工商管理学院
• 3:中兴公益卫生技术评估中心

摘要(Abstract)：

目的 通过Meta分析研究单髁置换术中局部应用氨甲环酸的安全性及疗效。方法 计算机检索CNKI、WANFANG、VIP、CBM、PubMed、Embase、Cochrane Library和Web of Science数据库，搜集并比较行单髁置换术患者局部应用氨甲环酸的随机对照试验(randomized controlled trials, RCTs),检索时限均为从建库到2021年8月1日。按Cochrane系统评价方法，由2名研究者独立进行文献筛选、资料提取并对纳入的研究进行质量评价，然后用RevMan 5.4软件对结局指标(血红蛋白减少量、引流量、总失血量、输血率、伤口并发症发生率、深静脉血栓发生率、住院时间)进行Meta分析。结果 经过严格筛选，最终11篇文章共801例接受单髁置换术的患者被纳入本研究，各研究基线资料均具可比性。Meta分析结果显示，单髁置换术中局部应用氨甲环酸在血红蛋白减少量、引流量、总失血量、输血率、伤口并发症发生率、深静脉血栓发生率、住院时间上均低于对照组，差异有统计学意义。(血红蛋白减少量I~2=46%,MD=-11.96,95%CI[-12.89,-11.02],P<0.05;引流量I~2=54%,MD=-67.06,95%CI[-67.34,-66.79],P<0.05;总失血量I~2=7%,MD=-145.67,95%CI[-145.97,-145.36],P<0.05;输血率I~2=0%,RR=0.19,95%CI[0.07,0.52],z=3.22,P<0.05;伤口并发症发生率I~2=0%,RR=0.00,95%CI[-0.03,0.03],z=0.09,P=0.93;深静脉血栓发生率I~2=0%,RR=0.11,95%CI[0.01,0.86],z=2.11,P<0.05;住院时间I~2=16%,MD=-0.25,95%CI[-0.69,0.19],z=1.10,P>0.05)。结论 单髁置换术中局部应用氨甲环酸能有效减少围手术期出血，降低输血率，减少术后血栓的发生。但由于纳入的研究样本量较小，结论尚需多中心、大样本量的RCTs的进一步验证。
Objective To study the safety and efficacy of topical application of tranexamic acid in Unicompartmental knee arthroplasty(UKA) by Meta analysis.Methods The CNKI,WANFANG,VIP,CBM,PubMed, Embase, Cochrane Library, and Web of Science databases were searched to collect and compare randomized controlled trials(RCTs) of topical tranexamic acid in patients undergoing UKA surgery.The search time limit is from the establishment of the database to August 1,2021.According to the Cochrane system evaluation method, the literature screening, data extraction and quality evaluation of the included studies were independently carried out by two researchers.And then Meta analysis was used to evaluate the outcome indicators(hemoglobin reduction, drainage volume, total blood loss, blood transfusion rate, the incidence of wound complications, the incidence of deep vein thrombosis, and the length of hospital stay) by RevMan 5.4 software.Results After rigorous screening, a total of 801 UKAs in 11 articles were finally included in this study, and the baseline data of each study were comparable.Meta-analysis results showed that the local application of tranexamic acid in UKA was lower in hemoglobin reduction, drainage, total blood loss, blood transfusion rate, wound complication rate, deep vein thrombosis rate, and length of stay in the control group.The difference was statistically significant.(Hemoglobin reduction I~2=46,MD=-11.96,95%CI[-12.89,-11.02],P<0.05;drainage I~2=54%,MD=-67.06,95%CI[-67.34,-66.79],P<0.05;total blood loss I~2=7%,MD =-145.67,95%CI[-145.97,-145.36],P<0.05;blood transfusion rate I~2=0%,RR=0.19,95%CI[0.07,0.52],z=3.22,P<0.05;wound complication rate I~2=0%,RR=0.00,95%CI [-0.03,0.03],z=0.09,P=0.93;the incidence of deep vein thrombosis I~2=0%,RR=0.11,95%CI[0.01,0.86],z=2.11,P<0.05;length of stay I~2=16%,MD=-0.25,95%CI[-0.69,0.19],z=1.10,P>0.05).Conclusion Local application of tranexamic acid in unicondylar replacement can effectively reduce perioperative bleeding, blood transfusion rate, and postoperative thrombosis.However, due to the small sample size of the included studies, the methodological quality is generally low, and the conclusions still need to be further verified by higher-quality RCTs.

关键词(KeyWords)： 氨甲环酸;单髁置换术;随机对照试验;局部;Meta分析
tranexamic acid;unicompartmental knee arthroplasty;randomized controlled trial;topical application;meta analysis

Abstract:

Keywords:

基金项目(Foundation): 北京语言大学校级项目资助(中央高校基本科研业务费专项资金)(22YJXZ0002)

作者(Author): 赵士清,郭青,孙权,张方
ZHAO Shiqing,GUO Qing,SUN Quan,ZHANG Fang

DOI: 10.14066/j.cnki.cn21-1349/r.2021.1479

参考文献(References)：

• [1] SONG H R,YU Z,WANG L M,et al.The clinical study unicondylar knee arthroplasty for unicompartmental knee osteoarthritis[J].Chinese Journal of Joint Surgery(Electronic Edition)[中华关节外科杂志(电子版)],2010,4(1):52-56.
• [2] WEN T,XUE H M,MA T,et al.Evaluation on the effect of tranexamic acid on decreasing bleeding volume after unicompartment knee arthroplasty[J].Orthopaedic Biomechanics Materials and Clinical Study(生物骨科材料与临床研究),2016,13(5):51-54,82.
• [3] LEMAIRE R.Strategies for blood management in orthopaedic and trauma surgery[J].J Bone Joint Surg.2008,90(9):1128-1136.
• [4] SCHWAB P E,LAVAND′HOMME P,YOMBI J C,et al.Lower blood loss after unicompartmental than total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2015,23(12):3494-3500.
• [5] LUO B,YUAN Y,YANG J F,et al.Effects of intraarticular injection of tranexamic acid combined with closed drainage tube on bleeding volume of unicom-partmental knee osteoarthritis after unicompartmental knee arthroplasty[J].Chinese Journal of Bone and Joint Injury(中国骨与关节损伤杂志),2018,33(6):579-582.
• [6] FENG S,WU J T,ZHA G C,et al.Effect of intra-articular injection of tranexamic acid on perioperative blood loss during unicompartmental arthroplastyduring unicompartmental arthroplasty[J].Chinese Journal of Bone and Joint Surgery(中华骨与关节外科杂志),2016,9(5):402-406.
• [7] WU J T,FENG S,CHEN X Y,et al.Intra-Articular Injection of Tranexamic Acid on Perioperative Blood Loss During Unicompartmental Knee Arthroplasty[J].Med Sci Monit,2019,25(16):5068-5074.
• [8] ZENG B,LIU G,HE Z S,et al.Effects of intraarticular tranexamic acid injection combined with 3-hour drainage tube occlusion postoperatively on blood loss in unicompartmental knee arthroplasty[J].Chinese Journal of Tissue Engineering Research(中国组织工程研究),2016,20(22):3197-3204.
• [9] DENG Z F,HE Z Y,LIU K,et al.Hemostatic effect and safety of intravenous combined with topical administration of tranexamic acid on unicompartmental knee arthroplasty[J].Chinese Journal of Tissue Engineering Research(中国组织工程研究),2020,24(36):5793-5799.
• [10] WU X F,YIN Z F,SUN B F,et al.Analysis of hemostatic effect of intra articular injection of tranexamic acid after minimally invasive unicompartmental knee arthroplasty[J].China Journal of Orthopaedics and Traumatology(中国骨伤),2020,33(11):1068-1071.
• [11] XIONG J W,FU S G,SHU J.Clinical effect of tranexamic acid combined with clip tube for 4 hours in the treatment of osteoarthritis of medial compartment of knee joint[J].Chinese Journal of Clinical Rational Drug Use(临床合理用药杂志),2020,13(30):161-163.
• [12] XU L B.Effect of intra-articular tranexamic acid pulse lavage on blood loss in unicompartmental knee arthroplasty[J].Journal of Clinical Orthopaedics(临床骨科杂志),2021,24(2):287-288.
• [13] ZHANG F.The effect of intra-articular tranexamic acid injection on unicompartmental knee arthroplasty patients′ blood loss volume in perioperative period [J].Osteoporos Int,2018,29(Suppl):S149-S565.
• [14] CAO H,LIU M T,WANG J M,et al.Effect of tranexamic acid on blood loss in medial unicompartmental knee arthroplasty[J].Orthopedic Journal of China (中国矫形外科杂志),2018;26(7):610-614.
• [15] BROWN N M,Sheth N P,Kenneth D,et al.Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty:a multicenter analysis[J].J Arthroplasty,2012,27(8 Supp1):86-90.
• [16] ZHOU Z K,HUANG Z Y,YANG H L,et al.Expert consensus on the application of tranexamic acid and anticoagulant for the enhanced recovery after orthopedic surgery in China[J].Chinese Journal of Bone and Joint Surgery(中华骨与关节外科杂志),2019,12(2):81-88.