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Clinical Effectiveness of Platelet-Rich Plasma for Long-Bone Delayed Union and Nonunion: A Systematic Review and Meta-Analysis
Li S, Xing F, Luo R, Liu M
Frontiers in medicine. 2021;8:771252
Abstract
BACKGROUND More recently, there was a series of clinical studies focusing on local administration of platelet-rich plasma (PRP) in long-bone fracture patients suffering from delayed union and nonunion. Therefore, we performed a systematic review to evaluate the effectiveness of PRP injection for treatment of patients with long-bone delayed union and nonunion. METHODS Relevant clinical trials were selected by the main bibliographic databases, including Medline, PubMed, Embase, Web of Science, and the Cochrane library, to evaluate the effectiveness of PRP for long-bone fracture patients diagnosed with delayed union or nonunion by two reviewers independently. The main outcomes included healing rate, healing duration, pain relief, functional outcome, and complications. RESULTS Finally, thirteen studies including four hundred and fifty-nine participants met the selection criteria and were included in this systematic review. These articles included three randomized controlled studies, one prospective study, and nine retrospective studies. 146 out of 155 (94.19%) patients treated with PRP during operation, and 144 out of 183 (78.69%) patients treated with PRP injection alone, exhibited bone consolidation. The healing rate of the PRP group (85.80%) was higher than that of the control group (60.76%). The mean bony union time of patients treated and untreated with PRP, were, respectively, 4.64 and 5.15 months. Four papers reported that PRP was effective in pain relief of patient with delayed union and nonunion. Complications, including small subcutaneous hematoma, subcutaneous swelling, and postoperative infection, were also reported in enrolled studies. CONCLUSIONS PRP is a promising alternative treatment for patients with long-bone delayed union and nonunion. PRP could successfully promote the healing rate and relieve the pain of patients with delayed union and nonunion. However, the long-term adverse side and functional outcome in application of PRP still need further large-scale trials and long-term follow-up. SYSTEMATIC REVIEW REGISTRATION https://www.researchregistry.com/browse-the-registry#home/registrationdetails/61dbd2f837e948001e68d5c5/, The identifying number is research registry 7525.
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2.
Comparative efficacy and safety of topical hemostatic agents in primary total knee arthroplasty: A network meta-analysis of randomized controlled trials
Li S, Chen B, Hua Z, Shao Y, Yin H, Wang J
Medicine. 2021;100(12):e25087
Abstract
BACKGROUND Topical hemostatic agents are commonly used for reducing perioperative blood loss and transfusion requirement in primary total knee arthroplasty (TKA), although the optimal option has yet to be defined. This study aimed to evaluate the efficacy and safety of topical hemostatic agents and rank the best intervention using the network meta-analysis (NMA) method. METHODS We searched Web of science, PubMed, and Cochrane Library database up to April 2020, for randomized controlled trials (RCTs) on topical hemostatic agents in primary TKA. The quality of included studies was assessed using the Cochrane "risk of bias" tool. Direct and indirect comparisons were performed for the result of network meta-analysis followed by consistency test. RESULTS Thirty seven RCTs with 3792 patients were included in this NMA and the pooled results indicated that tranexamic acid plus diluted epinephrine (TXA+DEP) displayed the highest efficacy in reducing total blood loss, hemoglobin drop and transfusion requirement. None of the included treatments was found to increase risk of thromboembolic events compared to placebo. According to the results of ranking probabilities, TXA+DEP had the highest possibility to be the best topical hemostatic agent with regard to the greatest comparative efficacy and a relatively high safety level. CONCLUSION Current evidence supports that administration of TXA+DEP may be the optimal topical hemostatic agent to decrease blood loss and transfusion requirement in primary TKA. More direct studies that focused on the topical application of TXA+DEP versus other treatments are needed in the future.
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3.
Tranexamic acid reduce hidden blood loss in posterior lumbar interbody fusion (PLIF) surgery
Xu D, Chen X, Li Z, Ren Z, Zhuang Q, Li S
Medicine (Baltimore). 2020;99(11):e19552
Abstract
BACKGROUND Posterior lumbar interbody fusion (PLIF) surgery is associated with significant blood loss; however, few studies have focused on hidden blood loss (HBL) in PLIF or its regulatory factors. The purpose of this study was to explore the HBL in PLIF surgery as well as the influence of tranexamic acid (TXA) on blood loss in PLIF. METHODS We performed a randomized controlled trial (RCT) and recruited patients undergoing PLIF into the study from November 2013 to April 2017. All participants were assigned to one of 2 groups according to a simple equal probability randomization scheme. At the end of PLIF surgery, for patients in the TXA group, the surgical field was immersed in TXA (1 g in 100 mL of saline solution) for 5 min before stitching the wound. For the control group, the surgical field was immersed in the same volume of normal saline. RESULTS In our study, the drainage volume during the first 24 h and the total postoperative drainage volume were significantly lower in patients in the TXA group than in the control group (P = .001). The hematocrit (Hct) of the drainage and calculation of blood contained in the drainage showed similar results. The mean length of hospital stay and rate of blood transfusion in the TXA group were less than those in the control group (P < .05). HBL was responsible for 45.6% of the total blood loss in PLIF, and both of the indicators in the TXA group were much lower than those in the control group. CONCLUSIONS PLIF is associated with massive perioperative HBL, but the application of topical TXA leads to less postoperative blood loss including less HBL, a lower blood product transfusion rate, and a shorter hospital stay for PLIF.
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4.
Drainage relieves pain without increasing post-operative blood loss in high tibial osteotomy: a prospective randomized controlled study
Li S, Yang J, Watson C, Lu Q, Zhang M, Miao Z, Luo D, Liu P
Int Orthop. 2020
Abstract
PURPOSE Drainage is a common procedure in high tibial osteotomy (HTO), but the benefits of drainage during HTO remain poorly investigated. This study was designed to investigate the effect of drainage on blood loss and early functional recovery in HTO. METHODS Altogether, 80 patients undergoing HTO were analyzed from August 2018 to September 2019. Patients were randomized into two groups: group A (drainage, n = 40) and group B (no drainage, n = 40). There were no intergroup differences in baseline parameters between the two groups, and the same surgical techniques and haemostatic methods were used. The mean follow-up time was 3.2 months. Blood loss and early functional recovery of the knee were examined post-operatively in both groups. RESULTS The total post-operative blood loss was 253.34 +/- 104.18 ml in group A and 222.51 +/- 106.89 ml in group B. This difference was non-significant (p > 0.05). The post-operative haemoglobin and haematocrit differences between groups were also non-significant (p > 0.05). Post-operative visual analogue scale (VAS) pain scores and lower leg swelling were lower in group A than those in group B (p < 0.05), and the early range of motion of the knee joint was higher in group A than that in group B (p < 0.05). Group A had lower incidence rates of dressing seepage and incision complications than group B (p < 0.05). The differences in three month post-operative VAS and knee function scores were non-significant (p > 0.05). CONCLUSION Drainage in HTO does not increase patients' total blood loss, but it can promote early knee function recovery by reducing post-operative pain, lower leg swelling, and the incidence of incision complications. TRIAL REGISTRATION NCT-03954860.
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5.
Sealing the Intramedullary Femoral Canal for Blood Loss in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials
Wang K, Yuan W, An J, Cheng P, Song P, Li S, Jiang J, Zhou H
The journal of knee surgery. 2019
Abstract
Blood loss after total knee arthroplasty (TKA) is a potentially serious medical problem since it leads to anemia, increased need for transfusion, and prolonged hospitalization. Some studies have reported that sealing of the intramedullary femoral canal during TKA may decrease postoperative blood loss. The purpose of this study is to determine the effects of sealing of the intramedullary femoral canal during TKA on blood loss and transfusion rate. Electronic databases, PubMed, EMBASE, the Cochrane Library, Web of Science, and Chinese Biomedical Database, were systematically searched. Only randomized controlled trials (RCTs) that compared the sealing group with the control group during TKA were included up to March 2019. Two reviewers independently extracted data and assessed the quality of included studies. The statistical analysis was performed by using Review Manager 5.3 software. Cochrane Risk of Bias tool was used for quality assessment. Overall, eight RCTs involving 996 patients met our criteria and were analyzed. The results of meta-analysis showed that patients in the sealed group had less total blood loss, less total drain output and less hidden blood loss, less transfusion rates, a lower drop of hemoglobin level at day 1 postoperatively, and less hematoma than the control group. On the other hand, there were no significant differences in infection, deep vein thrombosis, and redness of incision between sealed and control group. Current meta-analysis found that sealing the femoral canal during TKA was an effective method for the control of blood loss.
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6.
Efficacy of a single dose and an additional dose of tranexamic acid in reduction of blood loss in total knee arthroplasty
Sun Q, Yu X, Wu J, Ge W, Cai M, Li S
The Journal of Arthroplasty. 2016;32((7):):2108-2112
Abstract
BACKGROUND This study aimed at evaluating the efficacy and safety of different regimens with a single dose and an additional postoperative dose of tranexamic acid (TA) in reducing blood loss in total knee arthroplasty (TKA). METHODS A total of 180 patients who were scheduled to undergo primary unilateral TKA in our level I trauma center were recorded and divided into groups A, B, C, and D randomly. Preoperative dose, an additional postoperative dose, and 2 postoperative additional doses of TA were infused intravenously in groups A (30 mg/kg), B (15 mg/kg), and C (10 mg/kg), respectively, and TA was not infused in group D. Blood loss (intraoperative, postoperative, and total blood loss), blood transfusion rate and volume, hemoglobin level, and incidence of deep vein thrombosis were analyzed. RESULTS The total blood loss and postoperative blood loss were significantly lower in groups B and C without any difference between them. As for intraoperative blood loss, there was no significant difference between groups A and B and between groups B and C with superior efficacy than group D. CONCLUSION With the same total dose of TA, the preoperative dose and an additional dose of TA were superior to a single preoperative dose of TA in reducing blood loss in TKA. Besides, 1 additional dose was comparable to 2 additional doses of TA in reducing blood loss.