氨甲环酸在老年股骨粗隆间骨折患者围手术期的应用

Clinical study of elderly patients with intertrochanteric fracture of femur with perioperative treatment of methotrexate

目的探讨3种不同方法使用氨甲环酸在老年股骨粗隆间骨折患者围手术期应用的效果。方法老年股骨粗隆间骨折股骨近端防旋髓内钉(PFNA)内固定手术共119例,134例次,依照3种不同方法分为:A组(单纯静脉给药)44例次,B组(单纯局部给药)45例次,C组(静脉联合局部给药)45例次。对比分析3组患者年龄、体质指数及手术时间差异。于入院时、手术前、术后第1天,第3天及第7天复查血常规和D-二聚体并记录,计算术前隐性失血量,术后第1、3、7天失血量,术后隐性失血量,显性失血量,对比分析各组间差异。结果所有患者未发生肺梗死、脑梗死,A组患者术后发生小腿肌间静脉血栓2例,B组3例,C组2例,各组间差异无统计学意义(P>0.05)。3组患者年龄、体质指数、手术时间对比差异无统计学意义(P>0.05);3组患者在术前、术后各时间点D-二聚体3组间对比差异无统计学意义(P>0.05);3组术前失血量、术后第3天、术后第7天失血量对比差异无统计学意义(P>0.05);术后第1天失血量A组多于B组,多于C组,各组间对比差异有统计学意义(P<0.05);显性失血量A组多于B组和C组,A组和B、C组对比均差异有统计学意义(P<0.05),B组和C组对比差异无统计学意义(P>0.05);术前隐性失血量各组间差异无统计学意义(P>0.05),术后隐性失血量A组多于B组多于C组,3组之间均差异有统计学意义(P<0.05)。结论老年股骨粗隆间骨折患者围手术期应用静脉加局部联合使用氨甲环酸,更能有效减少患者显性失血量和隐性失血量,并无增加患者发生深静脉血栓风险。

Objective To investigate the effects of three different regimens of methotrexate in perioperative management of elderly patients with intertrochanteric fracture of femur.Methods From July 2015 to June 2018, 119 elderly patients with intertrochanteric femoral fractures were treated with PFNA internal fixation, among which 134 fractures were treated. According to the regimens of methotrexate administration, there were 44 cases in Group A(intravenous infusion), 45 cases in Group B(local TXA) and 45 cases in Group C(intravenous infusion combined with local TXA).The age, BMI and operation time were compared. The blood routine and D-dimer were examined and recorded at the time of admission, before operation, on the 1st day, on the 3rd day and on the 7th day after operation. The hidden blood loss before operation,blood loss on the 1st, the 3rd and the 7th day after operation, postoperative hidden blood loss and dominant blood loss were calculated for comparison. Results There was no pulmonary embolism or cerebral infarction in the three groups. There was no significant difference among the 3 groups(P>0.05). Intramuscular vein thrombosis occurred in 2 patients in Group A, 3 in Group B and 2 in Group C, with no significant difference among the 3 groups(P>0.05).There was no significant difference in age, BMI or operation time among the three groups(P>0.05). There was no significant difference in D-dimer among the three groups at each time point before or after operation(P>0.05). There was no significant difference in blood loss before operation, on the 3rd day or 7th day after operation(P>0.05). Postoperative blood loss in Group A was more than Group B and C on the first day. The dominant blood loss of Group A was significant more than Group B and C(P<0.05);while there was no significant difference between Group B and C(P>0.05). There was no significant difference in preoperative hidden blood loss among the 3 groups(P>0.05). Postoperative hidden blood loss in Group A was significantly more than Group B and C(P<0.05). Conclusion In the elderly patients with intertrochanteric fracture, intravenous and local use of methotrexate can effectively reduce the dominant and hidden blood loss, without increasing the risk of deep vein thrombosis.