氨甲环酸在肱骨髁间骨折治疗中的应用

Application of tranexamic acid in the treatment of humeral intercondylar fractures

目的探讨氨甲环酸(tranexamic acid,TXA)对肱骨髁间骨折切开复位内固定术后肘关节功能的影响。方法回顾性分析2015年1月至2018年1月我院收治的43例肱骨髁间骨折患者资料,男23例,女20例,年龄20~60岁,平均(42.6.2±10.6)岁。根据是否使用TXA分为两组,TXA组和单纯引流组。TXA组20例,在松止血带前30 min静脉滴注TXA 1 g,并在关闭切口后由引流管注入关节腔10 ml(1∶10 ml)TXA,夹闭2 h后放开;骨折根据AO/OTA分型C1型6例、C2型6例、C3型8例。单纯引流组23例,仅放置引流管并夹闭2 h后放开,骨折根据AO/OTA分型C1型8例、C2型6例、C3型9例。记录两组患者术前一般资料、术后引流量、骨折愈合时间等,末次随访时采用Mayo肘关节功能评分(mayo elbow performance score,MEPS)评定肘关节功能。结果所有患者获得术后12~24个月随访,平均(17.6±3.9)个月,所有患者骨折均获骨性愈合。两组患者在术前一般资料、术中失血量、术后第1、3天D-二聚体含量、骨折愈合时间等的差异均无统计学意义(P>0.05)。TXA组术后异位骨化发生率10.0%(2/20)远低于单纯引流组21.7%(5/23),但组间差异无统计学意义(P>0.05)。TXA组术后平均引流量(35.0±8.6)ml,肘关节平均伸-屈活动度为(128.9±16.1)°,MEPS平均得分(90.5±9.7)分,肘关节功能评价:优13例,良5例,可2例,优良率90.0%;单纯引流组,平均引流量(48.7±16.0)ml,肘关节平均伸-屈活动度为(112.2±33.2)°,MEPS平均得分为(83.0±13.2)分,肘关节功能评价:优8例,良9例,可4例,差2例,优良率73.9%,两组间差异有统计学意义(P<0.05)。结论肱骨髁间骨折切复内固定术后,应用TXA可以有效减少深部组织和关节腔内出血,减少粘连的发生,利于肘关节功能的恢复。

Objective To investigate the effect of tranexamic acid(TXA)on elbow joint function after open reduction and internal fixation in the treatment of humeral intercondylar fracture.Methods A retrospective analysis of 43 patients with humeral intercondylar fracture,admitted to our hospital from January 2015 to January 2018,were conducted.There were 23 males and 20 females with an average of(42.6±10.6)years(range:20-60 years).All patients were divided into TXA group and simple drainage group.TXA group(n=20):intravenous drip of TXA 1 g 30 minutes before loosening the tourniquet;TXA injection of 10 ml(1:10 ml)into the joint cavity through a drainage tube after incision closure;clamping for 2 h and release;there were 6 cases of type C1,6 cases of type C2 and 8 cases of type C3 according to the AO/OTA classification.Simple drainage group(n=23):drainage tube placement,clamping for 2 hours and release;there were 8 cases of type C1,6 cases of type C2 and 9 cases of type C3 according to AO/OTA classification.The general data before operation,postoperative drainage volume and fracture healing time of the two groups were recorded.At the last follow-up,the Mayo elbow performance score(MEPS)was used to assess the elbow joint function.Results All patients were followed up for 12 to 24 months,with an average of(17.6±3.9)months.All patients achieved bone healing.There were no significant differences in preoperative general data,intraoperative blood loss,D-dimer content on the 1st and 3rd day after operation,fracture healing time,etc.between the two groups(P>0.05).The incidence of postoperative heterotopic ossification in the TXA group(10.0%;2/20)was far lower than that in the simple drainage group(21.7%,5/23),but there were no statistically significant differences between the two groups(P>0.05).TXA group:the average postoperative drainage volume(35.0±8.6)ml;the average range of elbow flexion and extension(128.9±16.1)°;the average MEPS(90.5±9.7);the elbow function was excellent in 13 cases,good in 5 cases and fair in 2 cases;the excellent and good rate was 90.0%.Simple drainage group:the average drainage volume(48.7±16.0)ml;the average range of elbow flexion and extension(112.2±33.2)°;the average MEPS(83.0±13.2);the elbow function was excellent in 8 cases,good in 9 cases,fair in 4 cases and poor in 2 cases;the excellent and good rate was 73.9%.There were significant differences between the two groups(P<0.05).Conclusions After open reduction and internal fixation,TXA can effectively reduce bleeding in the deep tissue and joint cavity,lower the occurrence of adhesion,and benefit the recovery of elbow joint function in the treatment of intercondylar fracture of the humerus.