セメントレス人工膝関節置換術におけるトラネキサム酸投与の効果

Effects of Tranexamic Acid on Postoperative Blood Loss after Total Knee Arthroplasty

　背景：セメントレス人工膝関節置換術(以下，TKA)では，術後の出血対策は必要不可欠である．

　対象と方法：今回，初回TKA32症例を対象とし，ドレーンクランプ法(以下，DC法)とトラネキサム酸(以下，TA)の関節内投与あるいは静脈内投与の併用による出血抑制効果を検討した．

　結果：TA1g，2gの関節内投群および1gの静脈内投与群で出血抑制効果が認められたが，関節内投与群でより出血量が少なかった．また，TA1gと2gの関節内投与群間では出血抑制効果に差はなかった．

　まとめ：TKA術後の出血対策としてDC法とTA1gの関節内投与の併用は有効な方法である．

　Background：It is important to minimize postoperative blood loss after cementless total knee arthroplasty (TKA).

　Methods：Patients (n＝32) who underwent primary cementless TKA were divided into three study groups and a control group：a group that received an intra-articular injection of tranexamic acid (TA) 1 g, a group that received an intra-articular injection of TA 2 g, a group that received an intravenous injection of TA 1 g and in which the drain was clamped for 30 minutes postoperatively, and a group in which drain clamping alone was performed for 30 minutes postoperatively (control group).

　Outcome：Total blood loss was lower in the three study groups than in the control group.　The difference in total postoperative blood loss between the group that received the 1 g TA intra-articular injection and the group that received the 2 g injection was not statistically significant.

　Conclusion：Retrograde intra-articular injection of TA 1 g via the drain at the end of cementless TKA and clamping the drain for 30 minutes effectively reduced postoperative blood loss.