扩髓及氨甲环酸局部应用对股骨转子间骨折Gamma-3内固定失血的影响

Effect of reaming and topical application of tranexamic acid on blood loss for intertrochanteric fracture patients with Gamma-3 internal fixation

目的观察股骨转子间骨折患者采用闭合复位Gamma-3内固定手术股骨近端扩髓及局部应用氨甲环酸(TXA)对失血的影响及其安全性。方法选取该院2016年1月至2018年1月收治的行Gamma-3内固定手术老年股骨转子间骨折患者120例,并随机分为手术中股骨近端扩髓组(A组,n=59)和股骨近端不扩髓组(B组,n=61)。2组患者各分为2个亚组,A1组:近端扩髓后将TXA氯化钠注射液0.5g(50mL)注入股骨髓腔,在手术结束前将同样剂量TXA氯化钠注射液局部应用于切口周围软组织;A2组:用相同剂量生理盐水按A1组相同操作进行对照;B1组:将TXA氯化钠注射液1g(100mL)于手术结束前局部应用于周围软组织;B2组:用相同剂量生理盐水按B1组相同操作进行对照。计算各组患者隐性、显性失血量和总失血量,并观察下肢静脉血栓发生情况。结果A1组患者隐性失血量、总失血量均显著低于A2组,差异均有统计学意义(P<0.01);B1、B2组隐性失血量、总失血量比较,差异均无统计学意义(P>0.05)。与A2组比较,其他各组隐性失血量和总失血量明显减少,差异均有统计学意义(P<0.01)。各组患者下肢静脉血栓发生率比较,差异无统计学意义(P>0.05)。结论在老年股骨转子间骨折闭合复位Gamma-3内固定手术中,股骨近端扩髓是失血的独立危险因素。局部应用TXA可明显减少术后隐性失血量而不增加下肢静脉血栓发生风险。

Objective To observe the effect and safety of closed reduction Gamma-3 internal fixation for proximal femoral medullary reaming and TXA on blood loss in patients with intertrochanteric fractures. Methods 120 elderly patients with Gamma-3 internal fixation for intertrochanteric fractures admitted to the hospital from January 2016 to January 2018 were selected and randomly divided into the proximal femoral reaming group (group A, n =59) and the proximal femoral unreaming group (group B, n =61).Patients in the two groups were divided into two subgroups.Group A1:0.5 g (50 mL) of TXA sodium chloride injection was injected into the femoral bone marrow cavity after proximal medullary reaming,and the same dose of TXA sodium chloride injection was applied topically to the soft tissue around the incision before the end of surgery.Group A2:normal saline of the same dose was used as control according to the same operation of group A1.Group B1:1 g (100 mL) of TXA sodium chloride injection was applied topically to the surrounding soft tissue before the end of surgery.Group B2:normal saline of the same dose was used as control according to the same operation of group B1.Recessive,dominant blood loss and total blood loss were calculated and the incidence of venous thrombosis was observed. Results Recessive blood loss and total blood loss in group A1 were significantly lower than those in group A2,the differences were statistically significant ( P <0.01).There were no statistically significant differences in recessive blood loss and total blood loss between the group B1 and group B2 ( P >0.05).Compared with group A2,recessive blood loss and total blood loss were significantly reduced in other groups,the differences were statistically significant( P <0.01).There was no statistically significant difference in the incidence of venous thrombosis in lower extremities between the two groups ( P >0.05). Conclusion Proximal femoral reaming is an independent risk factor for blood loss in elderly patients undergoing closed reduction Gamma-3 internal fixation for intertrochanteric fractures.Local application of TXA can significantly reduce the postoperative recessive blood loss without increasing the risk of venous thrombosis in lower limbs.