股骨髓腔灌注氨甲环酸对髓内钉治疗老年股骨转子间骨折围手术期隐性失血及术后血栓风险的影响

Effect of femoral marrow cavity infusion of tranexamic acid on perioperative occult blood loss and risk of postoperative thrombosis during proximal femoral nail antirotation in senile intertrochanteric fracture

目的:探讨股骨近端防旋髓内钉(PFNA)固定术中股骨髓腔局部灌注氨甲环酸(TXA)对老年股骨转子间骨折患者围手术期隐性失血及术后血栓风险的影响。方法:回顾性分析2019年1月至2020年12月收治的63例老年股骨转子间骨折患者,37例在PFNA术中局部应用TXA纳入TXA组,26例术中不采用TXA的患者作为非TXA组。比较两组术中出血量、隐性失血量、围手术期抽血指标(血常规、凝血功能、血白蛋白)、输血情况、术后下肢深静脉血栓及肺栓塞情况等。结果:与非TXA组相比,TXA组围手术期有较低的隐性失血量[(192±205)ml vs.(578±277)ml,P<0.001]、隐性失血量占总血容量比例(4.95%±4.93%vs.16.60%±8.62%,P<0.001)、总失血量[(299±213)ml vs.(666±303)ml,P<0.001]。TXA组围手术期输血患者比例也低于非TXA组(24.3%vs. 75.7%,P<0.001)。凝血功能方面,TXA组能防止凝血酶原时间增加,使其更接近正常值。TXA组患者均未出现深静脉血栓及肺栓塞等术后并发症。结论:PFNA术中髓腔灌注TXA能有效地减少老年股骨转子间骨折患者术后隐性失血量,降低同种异体输血率,且对凝血功能影响少,不增加血栓风险,为临床上老年股骨转子间骨折治疗及加速康复提供更安全的辅助方法。

Objective: To investigate the effect of local infusion of tranexamic acid(TXA) into the femoral medullary cavity during proximal femoral nail antirotation(PFNA) on the risk of perioperative occult blood loss and postoperative thrombosis in senile intertrochanteric fracture. Methods: A total of 63 elderly patients with intertrochanteric femoral fractures treated from January 2019 to December 2020 were retrospectively analyzed. Local instillation of TXA in the femoral medullary cavity was performed in 37 patients during PFNA(TXA group), and 26 patients were not given TXA intraoperatively(non-TXA group). The final records were recorded to compare the intraoperative blood loss, occult blood loss, perioperative blood sampling indexes(blood routine, coagulation function,blood albumin), blood transfusion, and postoperative lower limb deep vein thrombosis and pulmonary embolism between the two groups. Results: Compared with the non-TXA group, the TXA group had lower perioperative occult blood loss([192±205] ml vs. [578±277] ml, P<0.001), the ratio of occult blood loss to total blood volume(4.95%±4.93% vs. 16.60%±8.62%, P<0.001) and total blood loss([299±213] ml vs. [666±303] ml, P<0.001). The proportion of patients with perioperative transfusion in the TXA group was lower than that in the non-TXA group(24.3% vs. 75.7%, P<0.001). Regarding coagulation function, the TXA group was able to prevent an increase in prothrombin time, bringing them closer to normal values. None in the TXA group developed postoperative complications such as deep vein thrombosis and pulmonary embolism. Conclusions: Intraoperative medullary infusion of TXA in PFNA can effectively reduce the postoperative occult blood loss and the rate of allogeneic transfusion in elderly patients with intertrochanteric fractures, and has less impact on coagulation function without increasing the risk of thrombosis, providing a safer adjunct to the rapid rehabilitation of clinical treatment of elderly intertrochanteric fractures.