氨甲环酸局部应用对跟骨骨折内固定改良L形切口术后愈合的影响

Effect of local application of tranexamic acid on healing of L-shaped incision for internal fixation of calcaneal fractures

目的观察氨甲环酸局部应用对跟骨骨折内固定改良L形切口术后愈合的影响及安全性分析。方法回顾性分析自2021-10—2023-02行改良L形切口锁定钢板内固定治疗的60例跟骨骨折,按随机数字表法分为观察组30例和对照组30例,对照组松止血带前30 min静脉滴注氨甲环酸(20 mg/kg,溶于100 mL生理盐水),观察组在此基础上联合闭创前局部浸润氨甲环酸(1 g,溶于20 mL生理盐水)3~5 min。比较两组手术时间、术后引流量、切口干燥时间、切口愈合时间、凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原以及并发症发生情况。结果60例均顺利完成手术,随访时间14~21 d,平均15.7 d。两组手术时间差异无统计学意义(P>0.05)。观察组术后引流量、切口干燥时间、切口愈合时间均优于对照组,差异有统计学意义(P<0.05)。两组术前及术后第1天凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原组间比较,差异均无统计学意义(P>0.05)。两组术后3 d、术后14 d复查未发现下肢深静脉血栓形成、肺栓塞。观察组术后皮缘坏死1例,皮下血肿1例;对照组皮缘坏死2例,浅表感染1例,皮下血肿4例。结论联合局部应用氨甲环酸可促进跟骨骨折内固定改良L形切口愈合,减少术后引流量,降低并发症发生率,且不会对患者凝血功能造成影响,安全性、可行性较高,值得临床推广应用。

Objective To observe the effect of tranexamic acid local application on the healing of calcaneal fractures after im⁃proved L-shaped incision operation and analyze its safety.Methods Sixty cases of calcaneal fractures treated with improved L-shaped incision locking plate from October 2021 to February 2023 were retrospectively analyzed.They were randomly divid⁃ed into observation group(30 cases)and control group(30 cases).The control group was given tranexamic acid(20 mg/kg,dis⁃solved in 100 mL physiological saline)intravenously 30 minutes before tourniquet loosening,while the observation group was combined with local infiltration of tranexamic acid(1 g,dissolved in 20 mL physiological saline)3-5 min before wound closure.The operation time,postoperative drainage,incision drying time,incision healing time,prothrombin time,activated partial thromboplastin time,fibrinogen and complications were compared between the two groups.Results All 60 cases were success⁃fully operated,and the follow-up time was 14-21 days,with an average of 15.7 days.There was no significant difference in oper⁃ation time between the two groups(P>0.05).The postoperative drainage,incision drying time and incision healing time in the ob⁃servation group were better than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in prothrombin time,activated partial thromboplastin time and fibrinogen between the two groups be⁃fore operation and on the first day after operation(P>0.05).No deep venous thrombosis and pulmonary embolism were found in the two groups at 3 days and 14 days after operation.In the observation group,there was 1 case of skin edge necrosis and 1 case of subcutaneous hematoma after operation.In the control group,there were 2 cases of skin edge necrosis,1 case of superficial in⁃fection and 4 cases of subcutaneous hematoma.Conclusion The local application of tranexamic acid can promote the healing of L-shaped incision for internal fixation of calcaneal fractures,reduce the postoperative drainage,reduce the incidence of com⁃plications,and will not affect the coagulation function of patients.It is safe and feasible,and is worthy of clinical application.