氨甲环酸对股骨粗隆间骨折围手术期出血情况的影响

Effect of Tranexamic Acid on Perioperative Blood Loss after Surgical Treatment in Intertrochanteric Fractures

目的:研究氨甲环酸对动力髋螺钉(DHS)和近端防旋髓内钉(PFNA)治疗股骨粗隆间骨折围手术期出血情况的影响。方法:对2012年至2015年在我院骨科的股骨粗隆间骨折68例患者进行回顾性研究。根据术前氨甲环酸的使用情况将患者分为氨甲环酸组和对照组,应用Gross线性方程计算失血总量和隐性失血量,比较各组间年龄、身高、体重、体重指数、手术时间的差异。分析采用DHS和PFNA手术的患者围手术期出血情况。结果:氨甲环酸组和对照组、PFNA和DHS患者的基本情况均无显著差异(P>0.05)。氨甲环酸组的总出血量显著少于对照组(P<0.05),而氨甲环酸组和对照组的术中出血量和隐性失血量则无显著差异(P>0.05)。DHS固定的患者中氨甲环酸组的隐性失血量和总失血量均显著小于对照组(P<0.05),而在PFNA固定的患者中氨甲环酸组和对照组中各出血量参数均无显著差异(P>0.05)。结论:术前应用氨甲环酸可以减少DHA的隐性失血量和总失血量,但对PFNA的隐性失血量和总失血量无显著影响。

Objective： To study the effect of tranexamic acid on perioperative blood loss after surgical treatment using proximal femoral nail anti-rotation（PFNA）or dynamic hip screw（DHS） in intertrochanteric fractures. Methods： The data of patients undergoing intertrochanteric fractures surgery treatment from 2012 to 2015 were collected. The patients were divided into tranexamic acid group and control group according to the use of tranexamic acid. The amount of total blood loss and the hidden blood loss were calculated using Gross equation. The data from patients were collected and compared including age, height, weight, body mass index, operation time and blood loss. Results： There were no significant difference in age, height, weight, body mass index, preoperative HB and HCT between and control group, PFNA and DHS（P〈0.05）. The total blood loss of tranexamic acid group was significantly decreased than that of control group（P〈0.05）. Bleeding during operation and hidden blood loss were not significantly different between tranexamic acid group and control group（P〈0.05）. The total blood loss and hidden blood loss of patients using DHS in tranexamic acid group were markedly lower than those in control group（P〈0.05）. There were no significant difference in total blood loss, hidden blood loss and operative blood loss between patients using PFNA in tranexamic acid group and control group（P〈0.05）. Conclusions： The preoperative use of tranexamic acid can decrease the total blood loss and the hidden blood loss in patients using DHS but not PFNA in the surgical treatment of intertrochanteric fractures.