静脉联合局部应用氨甲环酸减少股骨转子间骨折髓内固定术后失血的有效性及安全性研究  

Efficacy and safety of intravenous combined with topical administration of tranexamic acid in reducing blood loss after intramedullary fixation of intertrochanteric femoral fractures

作　　者：李海波[1] 刘大海 汤雪霞 王娜[1] 龚德志 吴严 张跃[1] 李汶 苟永胜 LI Haibo;LIU Dahai;TANG Xuexia;WANG Na;GONG Dezhi;WU Yan;ZHANG Yue;LI Wen;GOU Yongsheng(Department of Orthopaedics,West China-KongGang Hospital of Sichuan University(Chengdu Shuangliu District First People’s Hospital),Chengdu Sichuan,610200,P.R.China)

机构地区：[1]四川大学华西空港医院(成都市双流区第一人民医院)骨科,成都610200

出　　处：《中国修复重建外科杂志》2021年第5期550-555,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省医学会创伤课题(2015GK004)。

摘　　要：目的采用前瞻性对照研究,探讨静脉联合局部应用氨甲环酸(tranexamic acid,TXA)减少股骨转子间骨折髓内固定术后失血的有效性与安全性。方法以2015年6月—2019年7月拟行髓内固定术的股骨转子间骨折患者作为研究对象,其中120例符合选择标准纳入研究。将患者随机分为3组,其中静脉给药组(A组)41例、局部给药组(B组)40例、联合给药组(C组)39例。A组4例术前出现下肢深静脉血栓形成,1例术后第5天因心肌梗死死亡,1例术后发生严重肺部感染;B组2例术前出现下肢深静脉血栓形成,1例术中出现医源性骨折;C组3例术前出现下肢深静脉血栓形成,1例术前出现肺部感染放弃手术治疗。上述患者均剔除研究,余107例纳入分析,其中A、B、C组各35、37、35例。3组患者性别、年龄、身高、体质量、致伤原因、骨折侧别及类型、受伤至手术时间以及术前血红蛋白(hemoglobin,Hb)、红细胞压积等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术中A组于术前30 min静脉滴注TXA(15 mg/kg),B组术中于股骨近端开槽后及植入髓内钉前各注入1 g TXA至髓腔内,C组术前及术中参照A、B组给药方法及剂量给予TXA。记录并比较3组总失血量、Hb下降最大值、输血率、手术时间、骨折愈合时间以及相关并发症发生情况,采用Harris评分评价髋关节功能。结果 3组手术时间比较,差异均无统计学意义(P>0.05)。B组总失血量、Hb下降最大值及输血率均最高,A组其次,C组最低,组间比较差异均有统计学意义(P<0.05)。术后3组患者均无切口感染、肺栓塞发生。C组贫血发生率明显低于A、B组(P<0.05)。3组患者切口皮下血肿、无菌性渗出及下肢深静脉血栓形成发生率比较,差异均无统计学意义(P>0.05)。3组患者均获随访,随访时间8~35个月,平均16.2个月。A、B、C组骨折愈合时间分别为(6.12±1.78)、(5.89±1.63)、(5.94±1.69)个月,差异均无�Objective To investigate the efficacy and safety of intravenous combined with topical administration of tranexamic acid(TXA) in reducing blood loss after intramedullary fixation of intertrochanteric femoral fractures by a prospective controlled trial. Methods Patients with intertrochanteric femoral fractures, who were admitted for intramedullary fixation between June 2015 and July 2019, were selected as the study subjects, 120 of whom met the selection criteria. The patients were randomly assigned to 3 groups: intravenous administration group(group A, 41 cases),topical administration group(group B, 40 cases), and combined administrations group(group C, 39 cases). In group A,4 patients occurred deep vein thrombosis of lower extremity before operation, 1 patient died of myocardial infarction on the 5 th day after operation, and 1 patient developed severe pulmonary infection after operation. In group B, 2 patients occurred deep vein thrombosis of lower extremity before operation and 1 patient had iatrogenic fracture during operation.In group C, 3 patients occurred deep vein thrombosis of lower extremity before operation and 1 patient developed pulmonary infection before operation and gave up surgical treatment. All the above patients were excluded from the study, and the remaining 107 cases were included in the analysis, including 35, 37, and 35 cases in groups A, B, and C,respectively. There was no significant difference in gender, age, height, body mass, injury cause, fracture side and type, the interval between injury and operation, and preoperative hemoglobin(Hb), hematocrit between groups(P>0.05).Intraoperative TXA(15 mg/kg) was injected intravenously in group A at 30 minutes before operation, and 1 g of TXA was injected into the medullary cavity in group B after the proximal femur was grooted and before the intramedullary nail implantation, respectively. TXA was given in group C before and during operation according to the administration methods and dosage of groups A and B. Total blood loss, maximum Hb decrea

关 键 词：股骨转子间骨折 氨甲环酸 髓内固定 失血 

分 类 号：R687.3[医药卫生—骨科学]