联合应用氨甲环酸减少股骨转子间骨折PFNA内固定失血量的临床疗效

Clinical effect of combined application of tranexamic acid in reducing blood loss volume of PFNA internal fixation in treatment of femoral intertrochanteric fracture

目的评估术前联合静脉滴注和局部应用氨甲环酸对老年股骨转子间骨折的患者行股骨近端防旋髓内钉(PFNA)内固定围术期失血量及安全性的影响。方法选择2015年9月至2018年6月该院收治的股骨转子间骨折行PFNA内固定的老年患者80例,按照1∶1的比例随机分配到氨甲环酸组和对照组。氨甲环酸组术前30 min,以15 mg/kg氨甲环酸加入100 mL生理盐水静脉滴注;术中于股骨近端开槽后将1 g氨甲环酸溶于50 mL生理盐水注入髓腔内;于植入PFNA前再将1 g氨甲环酸溶于50 mL生理盐水注入髓腔内。对照组不使用氨甲环酸。记录两组患者一般资料(手术与受伤间隔时间、年龄、手术耗时、性别、体重指数等)。记录两组患者入院及术后1、3、5、10、14 d血红蛋白(Hb)和血细胞比容(HCT),入院及术后1、3、14 d D-二聚体,隐性失血量、显性失血量、围术期总失血量、输血率,术后1、14 d血栓性并发症发生情况。结果两组患者一般资料比较,差异均无统计学意义(P>0.05)。两组患者入院时Hb及HCT比较,差异无统计学意义(P>0.05)。氨甲环酸组患者术后1、3、5、10、14 d Hb及HCT均明显高于对照组(P<0.05)。两组患者术前及术后1、3、14 d D-二聚体比较,差异无统计学意义(P>0.05)。氨甲环酸组、对照组围术期失血量分别为(483.13±178.28)、(655.18±163.31)mL,隐性失血量分别为(364.25±45.37)、(531.78±47.28)mL,两组比较差异有统计学意义(P<0.05);显性失血量分别为(118.36±32.36)、(123.87±35.51)mL,两组比较差异无统计学意义(P>0.05)。氨甲环酸组、对照组输血率为分别为32.50%、55.00%,两组比较差异有统计学意义(P<0.05)。氨甲环酸组、对照组术后深静脉血栓发生率分别为10.00%、5.00%,两组比较差异无统计学意义(P>0.05)。结论静脉联合局部应用氨甲环酸可明显降低PFNA内固定股骨转子间骨折术后的失血量及输血率,且不增加术后并发症发生率。

Objective To evaluate the effect of preoperative combined intravenous infusion and local application of tranexamic acid on the perioperative blood loss volume and safety of proximal femoral nail antirotation(PFNA)in elderly patients with intertrochanteric fracture.Methods Eighty patients with intertrochanteric fracture of femur treated by PFNA internal fixation in the Shuangliu District First People′s Hospital from September 2015 to June 2018 were randomly assigned to the tranexamic acid group and the control group according to the ratio of 1∶1.In the tranexamic acid group,15 mg/kg of tranexamic acid adding to normal saline 100mL was intravenously infused at 30 min before operation;1 g of tranexamic acid was dissolved in 50 mL of normal saline and injected into the medullary cavity after notching the proximal femur;1 g of tranexamic acid was dissolved in 50mL of normal saline and injected into the medullary cavity before the implantation of intramedullary nail.The control group did not use tranexamic acid.The general data(time between operation and injury,age,operation time,gender,BMI,etc.)of the two groups were recorded.The hemoglobin(Hb)and hematocrit(HCT)after admission,and on postoperative1,3,5,10,14 d,D-dimer,recessive blood loss volume,dominant blood loss volume,total perioperative blood loss volume and blood transfusion rate on postoperative 1,3,14 d,and the occurrence of thrombotic complications were recorded in the two groups.Results There was no statistically significant difference in the general data between the two groups(P>0.05).There was no statistically significant difference in Hb and HCT at admission between the two groups(P>0.05).The Hb and HCT on postoperative 1,3,5,10,14 d in the tranexamic acid group were significantly higher than those in the control group(P<0.05).There was no statistically significant difference in D-dimer before operation and on postoperative 1,3,14 d between the two groups(P>0.05).The perioperative blood loss volumes in the tranexamic acid group and the control group were(483.13±178.28)mL and(655.18±163.31)mL,the latent blood loss volumes were(364.25±45.37)mL and(531.78±47.28)mL respectively,and the differences were statistically significant(P<0.05).The dominant blood loss volumes in the tranexamic acid group and the control group were(118.36±32.36)mL and(123.87±35.51)mL respectively,and the difference was not statistically significant(P>0.05).The transfusion rates of the tranexamic acid group and control group were 32.50%and 55.00%,and the difference was statistically significant(P<0.05).The incidence rates of postoperative deep vein thrombosis in the tranexamic acid group and the control group were 10.00%and 5.00%respectively,and the difference was not statistically significant(P>0.05).Conclusion Intravenous combined with local application of tranexamic acid can significantly reduce the blood loss volume and blood transfusion rate after PFNA fixation of femoral intertrochanteric fracture,which does not increase the incidence rate of postoperative complications.