SchatzkerⅤ、Ⅵ型胫骨平台骨折多轴锁定钢板内固定术前注射氨甲环酸对术后失血及血清炎性因子水平的影响  

Effect of multiaxial locking plate internal fixation combined with tranexamic acid on postoperative blood loss and serum inflammatory factors of Schatzker type Ⅴ and Ⅵ tibial plateau fractures

作　　者：姚亮 陈虹 张世东 胡骏 于安曼 YAO Liang;CHEN Hong;ZHANG Shidong(Department of Orthopedic,Ma'anshan VIth metallurgical hospital,Anhui,Ma'anshan 243000,China)

机构地区：[1]安徽省马鞍山十七冶医院骨科,243000

出　　处：《临床外科杂志》2022年第4期328-330,共3页Journal of Clinical Surgery

摘　　要：目的观察多轴锁定钢板内固定治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折术前注射氨甲环酸对术后失血及血清炎性因子水平的影响。方法2019年9月~2020年12月间收治的复杂胫骨平台骨折病人100例,均行多轴锁定钢板内固定治疗,采用掷硬币法随机分为两组,A组53例,手术切皮前给予15 mg/kg生理盐水,B组47例,给予静脉输注氨甲环酸15 mg/kg。比较两组病人围术期失血量及输血情况,术后24、72小时血红蛋白(Hb)、D-二聚体(D-Dimer)和纤维蛋白降解产物(FDP)。术前、术后7天血清中白细胞介素(IL)-1β、肿瘤坏死因子(TNF)-α和基质金属蛋白酶(MMP)-3的含量。结果B组输血率为21.28%,A组为41.51%,两组比较差异有统计学意义(P<0.05)。B组术后24小时Hb水平(114.83±11.94)g/L,A组(104.57±10.28)g/L;B组术后24小时D-Dimer水平(4.12±0.75)mg/L,A组(5.17±1.30)mg/L(t=-4.617);两组比较差异均有统计学意义(P<0.05)。术后7天,B组病人血清IL-1β为(24.22±6.16)ng/L、TNF-α(42.30±6.62)ng/L、MMP-3(11.57±2.13)g/L,A组分别为(30.95±5.50)ng/L、(56.09±6.50)ng/L、(15.63±2.41)g/L,两组比较差异均有统计学意义(P<0.05)。结论多轴锁定钢板内固定治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折术前注射氨甲环酸能有效降低术后失血量,减少术后Hb丢失。Objective To investigate the effect of multiaxial locking plate internal fixation combined with tranexamic acid on postoperative blood loss and serum inflammatory factors of Schatzker type V and VI tibial plateau fractures.Methods From September 2019 to December 2020,100 patients with complex tibial plateau fractures were randomly divided into group A Group B was treated with internal fixation with multi axis locking plate.Group A was given 15 mg/kg normal saline before skin incision,and group B was given 15 mg/kg intravenous tranexamic acid.The perioperative blood loss and blood transfusion of the two groups were compared,The perioperative blood loss and blood transfusion of the two groups were compared,the levels of Hemoglobin(HB),D-Dimer(D-dimer)and fibrin degradation product(FDP)were compared 24 and 72 hours after operation.the levels of Serum interleukin-1(IL-1),tumor necrosis factor-α(TNF-α)and matrix metalloproteinase-2(MMP-3)were compared before and after operation.Results The blood transfusion rate of group B was 21.28%,which was lower than that of group A 41.51%(P<0.05).The level of Hb in group B was higher than that in group A[(114.83±11.94)g/L VS(104.57±10.28)g/L],the levels of D-dimer in group B were lower than those in group A[(4.12±0.75)mg/L,(5.17±1.30)mg/L](all P<0.05).7 days after operation,the levels of serum IL-1,TNF-α and MMP-3 in group B[(24.22±6.16)ng/L,(42.30±6.62)ng/L,(11.57±2.13)g/L]were lower than that in the group A[(30.95±5.50)ng/L,(56.09±6.50)ng/L,(15.63±2.41)g/L](all P<0.05).Conclusion The application of multi axis locking plate internal fixation combined with tranexamic acid in Schatzker type Ⅴ and Ⅵ tibial plateau fractures can effectively reduce the postoperative blood loss,reduce the postoperative HB loss,and promote the rapid recovery of postoperative joint function.

关 键 词：胫骨平台骨折 氨甲环酸 失血量 炎症因子 

分 类 号：R687.3[医药卫生—骨科学]