氨甲环酸在股骨颈骨折全髋关节置换围手术期的应用

Application of tranexamic acid in total hip arthroplasty for patients with femoral neck fractures

目的:探讨氨甲环酸(TXA)在股骨颈骨折全髋关节置换术(THA)中的安全性和有效性,以及不同剂量TXA对术后输血率的影响。方法:回顾性分析2013年1月至2021年12月收治的行单侧初次THA的3286例患者的临床资料,其中股骨颈骨折患者1548例,股骨头坏死患者1738例。比较股骨颈骨折THA患者中使用TXA组和未使用TXA组、不同剂量TXA组间的输血率,以及使用TXA组下肢深静脉血栓、肺栓塞、脑梗死、心肌梗死和感染的发生率,并与股骨头坏死THA患者进行比较。结果:所有患者均获得随访,随访时间3~15个月,平均(8.1±3.9)个月。股骨颈骨折THA患者中使用TXA组和未使用TXA组的输血率(12.0%vs.80.9%,P<0.001)与股骨头坏死THA患者(11.2%vs.81.5%,P<0.001)比较,差异无统计学意义;股骨颈骨折THA患者中TXA 3~4 g组和TXA 1~2 g组的输血率(7.3%vs.14.6%,P<0.001)与股骨头坏死THA患者(6.6%vs.15.3%,P<0.001)比较,差异无统计学意义。股骨颈骨折和股骨头坏死THA患者使用TXA后的下肢深静脉血栓、肺栓塞、心肌梗死、脑梗死和感染的发生率无统计学差异。结论:TXA在股骨颈骨折THA患者中可以安全使用,能够显著降低输血率;与股骨头坏死THA患者比较,不增加下肢深静脉血栓、肺栓塞、脑梗死、心肌梗死和感染的发生率。

Objective:To investigate the safety and efficacy of tranexamic acid(TXA)used in total hip arthroplasty(THA)for patients with femoral neck fractures,and the effect of different doses of TXA on the postoperative blood transfusion rate.Methods:A retrospective analysis was conducted on 3286 patients who underwent unilateral initial THA from January 2013 to December 2021,including 1548 patients of femoral neck fractures and 1738 patients of femoral head necrosis.The blood transfusion rates of patients with femoral neck fractures who were treated with TXA in the THA,those who were not treated with TXA,and those who were treated with different doses of TXA were compared.The incidence of lower limb deep vein thrombosis,pulmonary embolism,cerebral infarction,myocardial infarction,and infection of TXA group were recrded and compared with the patients with femoral head necrosis receiving THA.Results:All patients were followed up for 3-15 months,with an average of(8.1±3.9)months.There was statistically significant difference in blood transfusion rates between the TXA group and the non TXA group in patients with the femoral head fractures(12.0%vs.80.9%,P<0.001),and there was no statistically significant difference in blood transfusion rates between the THA patients with femoral head fractures and the THA patients with femoral head necrosis(11.2%vs.81.5%,P<0.001).There was statistically significant difference in blood transfusion rates between the TXA 3-4 g group and the TXA 1-2 g group in THA patients with femoral neck fractures(7.3%vs.14.6%,P<0.001),and there was no statistically significant difference in blood transfusion rates between THA patients with femoral head fratures and the THA patients with femoral head necrosis(6.6%vs.15.3%,P<0.001).There was no significant difference in the incidence of lower limb deep vein thrombosis,pulmonary embolism,myocardial infarction,cerebral infarction and infection after the use of TXA in THA patients with femoral neck fractures and THA patients with femoral head necrosis.Conclusions:TXA can be safely used in THA patients with femoral neck fractures and can significantly reduce blood transfusion rates;compared with THA patients with femoral head necrosis,the incidences of lower limb deep vein thrombosis,pulmonary embolism,cerebral infarction,myocardial infarction and infection do not increase in THA patients with femoral head fractures.