局部应用氨甲环酸和止血纱布减少股骨粗隆间骨折手术失血

Local application of tranexamic acid and absorbable hemostatic gauze for reducing blood loss in PFNA for femoral intertrochanteric fractures in the elderly

[目的]探讨髓腔内局部应用氨甲环酸和可吸收止血纱布减少高龄股骨粗隆间骨折PFNA内固定术后失血的疗效和安全性。[方法]高龄股骨粗隆间骨折PFNA内固定手术患者96例随机分为四组:A组未使用任何止血剂、B组单纯使用可吸收止血纱布、C组单纯使用氨甲环酸组、D组联合应用氨甲环酸及止血纱布。计算隐性失血量、显性失血量、围手术期总失血量、输血率,记录血栓性并发症发生情况。[结果]术后血红蛋白依A组~D组的顺序增加,组间差异有统计学意义(P<0.05)。而术后总失血量、隐性失血量、引流量依A组~D组的顺序减小,组间比较差异具有统计学意义(P<0.05)。此外,输血量也依A组~D组的顺序减少,任何两组间比较差异均具有统计学意义(P<0.05)。术后7 d或出院时,四组患者均未出现下肢静脉血栓或肺栓塞。[结论]在减少失血方面,单纯使用可吸收止血纱布优于不使用任何止血方法,单纯用氨甲环酸优于单纯用可吸收止血纱布,而将可吸收止血纱布与氨甲环酸局部联合效果最佳,且不增加血栓性疾病的发生风险。

[Objective] To evaluate the efficacy and safety of topical use of tranexamic acid （TXA） and absorbable hemostat- ic gauze into the medullary cavity after proximal femur reaming in the proximal femoral nail antirotation （PFNA） for treatment of femoral intertrochanteric fracture in the elderly to reduce blood loss. [Methods] A total of 96 elderly patients with femoral inter- trochanteric fracture treated by PFNA were randomly divided into the 4 groups as follows： the Group A had no any hcmostatic in- terference given, the Group B received absorbable hemostatic gauze only, the Group C was given TXA only, whereas the Group D received local TXA combined with absorbable hemostatic gauze. The total perioperative blood loss, hidden blood loss, visible blood loss, transfusion rate, and complications of vascular events were compared among the 4 groups. [Results] After operation, the hemoglobin sequentially increased from the Group A to the Group D, with a statistical difference among the groups （P〈 0.05）. Conversely, the total blood loss, hidden blood loss, and drainage volume significantly decreased in the order from Group A to the Group D （P〈0.05）. Additionally, blood transfusion significantly reduced in this order of Group A to D, associated with statistical differences between any two groups. At 7 days ＇after operation or at discharge, no any patient of the 4 groups was noted deep vein thrombosis in the lower extremity or pulmonary embolism by clinical examination or vascular Doppler ultrasound. [Conclusion] Regarding to reducing blood loss in PFNA, merely absorbable hemostatic gauze used is superior to no hemostatic used, while merely TXA used is superior to merely absorbable hemostatic gauze used, whereas combined usage of absorbable hemostatic gauze and TXA achieves the best outcome without increasing risks of vascular events complications.