氨甲环酸在旋后外旋型Ⅳ度踝关节骨折术中的疗效分析

Efficacy analysis of tranexamic acid in the ankle joint fracture surgery with grade Ⅳ supination external rotation type

目的通过回顾性研究80例旋后外旋型IV度踝关节骨折患者资料,探索氨甲环酸(tranexamie acid,TXA)在旋后外旋型IV度踝关节骨折切开复位内固定术的应用,比较其术中术后出血量.并发症及术后疼痛评分并进行疗效分析。方法回顾性分析2015年2月一2019年12月阜阳市妇女儿童医院收治的80例旋后外旋型IV度踝关节骨折患者资料,根据术前是否使用TXA及术中是否使用止血带分为3组,A组:术前使用TXA且术中未使用止血带,26例;B组:术前未使用TXA且术中使用止血带,29例;C组:术前未使用TXA且术中未使用止血带,25例。计算患者总失血量、显性失血量、隐性失血量及术后VAS评分,比较分析3组患者失血量及相关并发症情况。结果术前一般资料比较3组差异无统计学意义(均P>0.05)。A组患者总失血量为(170.6±12.2)mL,隐性失血量为(89.8±7.0)mL,显性失血量(80.8±11.1)mL;B组患者总失血量为(215.4±39.5)mL,隐性失血量为(187.8±39.9)mL,显性失血量(27.6±7.4)ml;C组患者总失血量为(298.8±31.2)mlL,隐性失血量为(143.3±22.4)mL,显性失血量(155.5±19.1)mL。A组和B组总失血量显著低于C组,A组隐性失血量显著低于B组和C组,B组显性失血量显著低于A组和C组,差异具有统计学意义(均P<0.05)。A组术后第1.2.3天VAS评分较B.C组减少,差异具有统计学意义。术后随访3个月,其中B组1例,C组3例切口愈合不良,经过加强换药后愈合良好。结论旋后外旋型IV度踝关节骨折切开复位内固定术前使用TXA可有效降低术后总失血量及隐性失血量,且不增加术后相关并发症的发生率,可降低术后疼痛评分,在创伤骨科具有良好的应用前景。

Objective To explore the application of tranexamie acid(TXA)in the ankle fracture fixation surgery with grade IV supination extermal rotation type.Methods Total 80 cases with grade IV supination external rotation ankle fractures from February 2015 to December 2019 were retrospeetive analyzed.According to whether the use of intraopera-tive tourmiquet or preoperative tranexamic acid,patients were divided into three groups,group A(26 cases):the tranex-amic acid was employed in preoperative and intraoperative tourniquet was not used,group B(29 cases):the tranexamic acid was not employed and intraoperative tourniquet was used,group:C(25 cases):the tranexamie acid and tourmiquet were not used.The total blood loss,overt blood loss,hidden blood loss and postoperative VAS score were gathered.The blood loss and related complications was comparative analysis between the three groups.Results The general informa-tion preoperative of three groups were not stistically significant(all P>005).The total blood loss,hidden blood loss,and overt blood loss in the group A were(170.6±12.2)mL,(89.8±7.0)mL,(80.8±11.1)mL respectively,in the group B were(215.4±39.5)mL,(187.8±39.9)mL,(27.6±7.4)mL respectively,and in the group C were(298.831.2)mL,(143.322.4)ml,(155.519.1)mL respectively.The total amount of blood loss in group A and group B were significantly lower than group C,the amount of the hidden blood loss of group A was significantly lower than group B and group C,and the amount of overt blood loss of group B was significantly lower than group A and group C(all P<0.05).The VAS scores 1,2,3 days after surgery of group A were signifcantly lower than group B and group C(all P<0.05).Followed up for 3 months,there were 1 poor healing of incision case in group B and 3 poor healing of incision cases in group C,and the wound healed well after strengthening dressing change.Conclusion The tranexamic acid used in the ankle fracture fixation surgery with the grade IV rotation of extermal rotation type can reduce the total amount of blood loss and postoperative blood loss,does not increase the incidence of postoperative related complications,and can reduce the postoperative pain score.It is in line with the concept of rapid rehabilitation actively advocated by the state,and has a good application prospect in the traumatie orthopedics.