Vol.5 No.4 (December 2016)
Comparison of the Hemostatic Effect of Local Application of Bone Wax and Tranexamic Acid in Total Hip Arthroplasty in Osteonecrosis of the Femoral Head
梁法瑞 ：青岛大学医学部，山东 青岛
韦标方 ：临沂市人民医院骨科，山东 临沂
Objective: To compare and analyze the effectiveness of bone wax and tranexamic acid in reducing the blood loss associated with unilateral primary THA in patients with osteonecrosis of the femoral head. Methods: A retrospective study was carried out to analyze the cases of 152 patients who received primary unilateral THA and satisfied inclusion and exclusion criteria during July 2014 to July 2016 in Linyi City People’s Hospital of the femoral head specialist. The patients were divided into four groups according to the use of bone wax and tranexamic acid. In group A, neither bone wax nor tranexamic acid was used. In group B, bone wax was used while tranexamic acid was not. In group C, tranexamic acid was used while bone wax was not. In group D, bone wax and tranexamic acid were both used topically. The bone wax and tranexamic acid in reducing blood loss in unilateral primary THA were evaluated through assessing the intraoperative blood loss, postop-erative visible blood loss, postoperative hemoglobin change, total blood loss, blood transfusion rate, clinical effects and other indicators. Results: No difference of statistical significance (p > 0. 05) was found among the 4 groups in terms of gender, age, BMI, preoperative Hb, PLT, PT, APTT, operation time, intraoperative blood loss and hip Harris score at 6 months postoperative. The total blood loss of the 4 groups was not all the same; the difference was of statistical significance (p < 0.05). The total blood loss of group B was significantly lower than that of group A; the difference was of statistical significance (p < 0.05). The total blood loss of group C and group D was significantly lower than that of group B; the difference was of statistical significance (p < 0.05). There was no significant difference between group C and group D (p > 0.05). The postoperative visible blood loss and blood transfusion rate of the 4 groups were not all the same; the difference was statistical significance (p < 0.05). There was no significant difference between group A and group B (p > 0.05). The postoperative visible blood loss and blood transfusion rate of group C and group D were significantly lower than those of group B. The difference was statistical significance (p < 0.05); there was no significant difference in complications and functional recovery among the 4 groups (p > 0.05). Conclusion: Bone wax or tranexamic acid can significantly reduce blood loss in patients with osteonecrosis of the femoral head underwent unilateral primary THA, but compared with tranexamic acid, bone wax cannot reduce the blood transfusion rate. The effectiveness of combination of both is better than bone wax alone while not better than that of tranexamic acid alone. Both bone wax and tranexamic acid will not increase the incision infection, healing and ve-nous thrombosis risk, and it does not affect postoperative functional rehabilitation.
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