氨甲环酸伤口灌注联合双反牵引微创复位植骨内固定治疗SchatzkerⅢ型胫骨平台骨折患者失血情况分析

Analysis of blood loss in patients with SchatzkerⅢ tibial plateau fracture treated with tranexamic acid wound perfusion combined with double reverse traction minimally invasive reduction,bone grafting and internal fixation

目的 分析氨甲环酸伤口灌注联合双反牵引微创复位植骨内固定治疗SchatzkerⅢ型胫骨平台骨折患者的失血情况。方法 回顾型性分析2019年7月—2020年7月湖北省长阳土家族自治县中医院收治的行患者双反牵引微创复位植骨内固定治疗的SchatzkerⅢ型胫骨平台骨折患者92例,根据是否使用氨甲环酸进行手术伤口灌注分为观察组45例和对照组47例。2组均行双反牵引微创复位植骨内固定术,对照组患者手术切口使用生理盐水进行局部灌注,观察组则使用氨甲环酸进行局部灌注。比较2组患者手术综合指标,术前术后纤溶指标[血清纤溶酶原激活物抑制剂-1(PAI-1)、组织型纤溶酶原激活物(t-PA)、凝血酶原时间(PT)],术后引流量、肢体周径变化及术后并发症发生情况。结果 观察组患者显性失血量、隐性失血量均少于对照组(P<0.01);观察组输血例数3例(6.67%),少于对照组的13例(27.66%),差异有统计学意义(χ^(2)=7.052,P=0.008);术后,2组PAI-1、t-PA水平较术前升高,PT较术前延长,但观察组升高或延长幅度小于对照组(P<0.05或P<0.01);观察组术后引流量少于对照组,术后肢体周径小于对照组(P均<0.01);观察组伤口红肿渗出发生率为2.22%,低于对照组的14.89%(χ^(2)=4.649,P=0.031),2组伤口皮下淤斑发生率和术前、术后3 d及出院前下肢深静脉血栓发生率比较差异均无统计学意义(P>0.05)。结论 氨甲环酸可明显减少双反牵引微创复位植骨内固定治疗SchatzkerⅢ型胫骨平台骨折患者的围术期出血量和引流量,抑制纤溶系统激活,不增加术后下肢深静脉血栓的发生概率,减少术后伤口并发症的发生。

Objective To analyze the blood loss of patients with SchatzkerⅢ tibial plateau fracture treated with tranexamic acid wound perfusion combined with double reverse traction minimally invasive reduction,bone grafting and internal fixation. Methods A retrospective analysis of 92 patients with SchatzkerⅢ tibial plateau fracture who were treated with double reverse traction minimally invasive reduction and bone grafting and internal fixation in Changyang Tujia Autonomous County Hospital of Traditional Chinese Medicine in Hubei Province from July 2019 to July 2020. The patients were divided into observation group of 45 cases and control group of 47 cases. Both groups were treated with double-reverse traction and minimally invasive reduction and bone grafting internal fixation. The patients in the control group were treated with normal saline for local perfusion,while the observation group was treated with tranexamic acid. Comparison of comprehensive surgical indexes,preoperative and postoperative fibrinolysis indexes[serum plasminogen activator inhibitor-1( PAI-1),tissue plasminogen activator( t-PA),prothrombin time( PT) ],postoperative drainage volume,changes in limb circumference and postoperative complications were compared between the two groups. Results The apparent blood loss and hidden blood loss in the observation group were lower than those in the control group( P < 0. 01);The number of blood transfusion cases in the observation group was 3 cases( 6. 67%),which was less than 13 cases in the control group( 27. 66%),and the difference was statistically significant( χ^(2)= 7. 052,P = 0. 008);After operation,the levels of PAI-1 and t-PA in the two groups were higher than those before operation,and the PT was prolonged,but the increase or prolongation in the observation group was smaller than that in the control group( P < 0. 05 or P < 0. 01);The postoperative drainage volume of the observation group was less than that of the control group,and the postoperative limb circumference was smaller than that of the control group( all P <0. 01);The incidence of wound redness,swelling and exudation in the observation group was 2. 22%,which was lower than14. 89% in the control group( χ^(2)= 4. 649,P = 0. 031);There was no significant difference in the incidence of subcutaneous ecchymosis and the incidence of lower extremity deep vein thrombosis before operation,3 days after operation and before discharge between the two groups( P > 0. 05). Conclusion Tranexamic acid can significantly reduce the perioperative blood loss and drainage of patients with SchatzkerⅢ tibial plateau fractures treated with double reverse traction minimally invasive reduction and bone graft internal fixation,inhibit the activation of the fibrinolytic system,do not increase the incidence of deep venous thrombosis of the lower limbs after surgery,and reduce the occurrence of postoperative wound complications.