局部应用氨甲环酸对老年不稳定转子间骨折行股骨近端防旋髓内钉围手术期失血量及安全性研究

Effectiveness and safety of topical use of tranexamic acid for reducing perioperative bleeding in elderly patients with unstable femoral intertorchanteric fracture undergoing PFNA operation

目的:评估局部应用氨甲环酸(tranexamic acid, TXA)对老年不稳定股骨转子间骨折的患者行股骨近端防旋髓内钉(proximal femoral nail antirotation, PFNA)围手术期失血量的影响。方法:选择2014年3月至2017年3月承德医学院附属医院收治的不稳定股骨转子间骨折行PFNA内固定的老年患者60例,分为局部治疗组(A组)和对照组(B组)。A组在术中扩髓后,置入主钉前给予2gTXA (溶于20mL生理盐水),B组不使用TXA。记录术前及术后第1、3、5天血红蛋白及红细胞压积,2组隐性失血量、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:A、B 2组围手术期失血量、隐性失血量,差异具有统计学意义(P<0.05)。A、B 2组显性失血量及引流量相比,差异无统计学意义(P>0.05)。A、B组输血率为分别为13.3%, 50.0%,差异具有统计学意义(P <0.05)。术后在血栓并发症方面差异无统计学意义(P>0.05)。结论:TXA局部髓腔用药可明显降低PFNA固定不稳定转子间骨折围手术期失血量,并且以隐性失血为主,同时降低了输血率,且不增加术后深静脉血栓(deep venous thrombosis, DVT)、肺栓塞(pulmonany embolism, PE)等并发症发生率。

Objective： To evaluate the efficacy and safety of topical use of tranexamic acid （TXA） for blood salvage after unstable femoral intertorchanteric fracture fixation with PFNA in elderly people. Methods： A total of 60 elderly patients with unstable intertrochanteric fracture undergoing PFNA from March 2014 to March 2017 were divided into two groups. Hemoglobin （Hb） and hematocrit （Hct） were measured before operation and at 1, 3, 5 d post-operation. The total perioperative blood loss, hidden blood loss, visible blood loss, transfusion rate, and complications of vascular events were compared between the two groups. Results： The perioperative blood loss and occult blood loss in group A and group B were significantly different （P 〈0. 05） . There was no significant difference in the two groups of dominant blood loss and drainage volume between group A and B （P〉 0. 06） . The blood transfusion rates in group A and group B were 13. 3% and 50. 0% respectively, and the difference was statistically significant （P 〈 0. 05） . There was no significant difference in postoperative thromboembolic complications （P 〉0. 05） . Conclusion： Intramedullary administration of tranexamic acid can significantly reduce perioperative blood loss in PFNA fixation of unstable intertrochanteric fractures, mainly occult blood loss, while reducing the rate of blood transfusion, and does not increase the incidence of postoperative DVT, PE and other complications.