BACKGROUND:Total knee arthroplasty is always associated with peripheral blood loss.Blood transfusion not only involves additional cost and prolongs rehabilitation time,but also carries substantial risk of immunologic reaction and disease transmission.Therefore it is very important to reduce blood loss of total knee arthroplasty.OBJECTIVE:To investigate the efficacy and safety of tranexamic acid on reducing blood loss after total knee arthroplasty.METHODS:We enroled 64 patients with primary osteoarthritis undergoing a unilateral total knee arthroplasty and randomized them into two groups,with 32 patients in each group.Tranexamic acid group: patients received intravenous drop infusion of tranexamic acid dissolved in 250 mL normal saline (10 mg/kg) at 15 minutes before operation; control group: patients just received 250 mL normal saline.Intraoperative blood loss,postoperative blood loss,postoperative hemoglobin levels,amount of blood transfusion,and number of patients requiring blood transfusion were compared.Fibrinogen,prothrombin time and other coagulation indicators were also examined before operation and 3 hours after operation.Deep vein thrombosis in both limbs of al patients was examined bythe color Doppler ultrasonography 30 days after operation.RESULTS AND CONCLUSION:There was no significant difference in intraoperative blood loss between the two groups (P＞0.05).Postoperative volume of blood loss was lower in the tranexamic acid group than in the control group (P＜0.001).The amount of blood transfusion and number of patients requiring blood transfusion were lower in the tranexamic acid group than in the control group (P＜0.001).The postoperative hemoglobin levels were obviously higher in the tranexamic acid group than in the control group (P＜0.001).There was no significant difference in coagulation indicators between two groups at postoperative 3 hours,but D-dimer value in the two groups was significantly higher than that before surgery,and the tranexamic acid group was lower than the control group (P＜0.001).No cases appeared deep vein thrombosis after operation.Experimental findings indicate that,tranexamic acid can effectively reduce postoperative blood loss and blood transfusion,as wel as number of blood transfusions after total knee arthroplasty.And it did not increase the risk of deep vein thrombosis.

BACKGROUND:Simple pedicle screw fixation for thoracolumbar fractures has better outcomes, but there are some deficiencies, such as poor applicability for severe compression or burst fractures, strong vertebral pain, easy to cause vertebral wound denervation and paraspinal muscle injury, and slow recovery. OBJECTIVE:To investigate the clinical effects of pedicle screw fixation combined with artificial bone graft for the treatment of thoracolumbar fractures. METHODS:A total of 126 patients with thoracolumbar vertebral compression fractures, who had undergone pedicle screw fixation without bone graft (control group,n=62) and with bone graft (test group,n=64) were enroled. The fracture healing, anterior vertebral height ratio, sagittal Cobb angle, and loss rate of vertebral height after 6 months were observed by X-ray in the two groups. RESULTS AND CONCLUSION:Al patients were folowed up, and had complete fracture healing after 12-16 months. The anterior vertebral height and Cobb angle were both improved in the two groups at 1 week after operation (P < 0.01), but there was no difference between the two groups (P > 0.05). New bone formation was observed in the test group at 6 months after operation, and patients were pain-free; but the speed of bone formation was slower in the control group, and patients stil suffered from painful thoracolumbar fractures. There was no difference in the loss of anterior vertebral height and Cobb angle between the two groups (P> 0.05). These findings indicate that pedicle screw fixation combined with artificial bone graft lead to a better recovery in thoracolumbar fractures.