局部应用氨甲环酸减少老年股骨颈骨折全髋关节置换后引流的安全和有效性

Safety and effectiveness of topical application of tranexamic acid to reduce drainage of elderly femoral neck fractures after total hip arthroplasty

背景:局部应用氨甲环酸可减少退变性疾病行全髋关节置换后的引流,但其应用于单纯老年股骨颈骨折行初次全髋关节置换的研究报道相对较少。目的:分析局部应用氨甲环酸减少老年股骨颈骨折患者全髋关节置换后引流的安全和有效性。方法:纳入2019年1至12月郑州人民医院收治的45例老年股骨颈骨折患者,男19例,女26例,年龄59-82岁,均接受全髋关节置换治疗,其中21例全髋关节置换手术完成缝皮后经引流管逆行注入氨甲环酸(观察组),24例全髋关节置换手术完成缝皮后经引流管逆行注入生理盐水(对照组)。记录术后引流量与不良事件发生情况,密切观察切口愈合情况,检查凝血功能。试验获得郑州人民医院医学伦理委员会批准。结果与结论:①所有患者术后切口均甲级愈合,术后未出现心肌梗死、脑梗死、肺栓塞、下肢深静脉血栓;②观察组术后3 d内的总引流量、血红蛋白丢失量少于对照组(P<0.05);③两组术后活化部分凝血酶原时间、凝血酶原时间、凝血酶时间、纤维蛋白原比较差异无显著性意义(P>0.05);④结果表明,局部应用氨甲环酸在老年股骨颈骨折患者全髋关节置换中安全有效,在不影响凝血功能的情况下可显著减少术后引流量。

BACKGROUND:Topical application of tranexamic acid can reduce the drainage after total hip arthroplasty for degenerative diseases.However,there are few reports on the application of tranexamic acid in primary total hip arthroplasty for simple elderly femoral neck fracture.OBJECTIVE:To analyze the safety and effectiveness of topical application of tranexamic acid to reduce drainage of elderly femoral neck fractures after total hip arthroplasty.METHODS:Forty-five elderly femoral neck fractures patients undergoing total hip arthroplasty in the Zhengzhou People’s Hospital from January to December 2019 were enrolled in this study,including 19 males and 26 females at the age of 59-82 years old.Twenty-one patients in the observation group were injected with tranexamic acid retrogradely through the drainage tube after total hip arthroplasty.Twenty-four patients in the control group were injected with normal saline retrogradely through the drainage tube after total hip arthroplasty.The postoperative drainage volume and adverse events were recorded;the wound healing was closely observed;and the coagulation function was checked.This study was approved by the Medical Ethics Committee of Zhengzhou People’s Hospital.RESULTS AND CONCLUSION:(1)All patients’incisions healed grade A,and no myocardial infarction,cerebral infarction,pulmonary embolism,or deep vein thrombosis of the lower extremities occurred.(2)At postoperative 3 days,total drainage and hemoglobin loss were less in the observation group than those in the control group(P<0.05).(3)Activated partial prothrombin time,prothrombin time,thrombin time,and fibrinogen were not significantly different between the two groups after surgery(P>0.05).(4)Results suggested that topical application of tranexamic acid in total hip arthroplasty for elderly femoral neck fractures is safe and effective.It can significantly reduce postoperative drainage without affecting coagulation function.