腰椎退行性疾病后路椎管减压植骨融合内固定术中局部应用氨甲环酸的安全性和有效性  

Safety and efficacy of topical application of tranexamic acid in posterior spinal canal decompression and bone grafting fusion internal fixation for lumbar degenerative diseases

作　　者：郝申申 王鹏程 董胜利 李洪珂 刘帅 孟赛克 康凯[2] HAO Shen-shen;WANG Peng-cheng;DONG Sheng-li;LI Hong-ke;LIU Shuai;MENG Sai-ke;KANG Kai(Department of Spine and bone tumor,General Hospital of Pingmei Shenma Medical Group,Pingdingshan,Henan 467000,China;不详)

机构地区：[1]平煤神马医疗集团总医院脊柱骨科骨肿瘤科,河南平顶山467000 [2]延安大学附属医院脊柱骨科,陕西延安716000

出　　处：《中国骨与关节损伤杂志》2022年第7期701-704,共4页Chinese Journal of Bone and Joint Injury

基　　金：平顶山市2019年生命健康产业科技发展计划(平科[2019]2号);河南省科技发展计划(172102310525)。

摘　　要：目的分析腰椎退行性疾病后路椎管减压植骨融合内固定术中局部应用氨甲环酸的止血有效性。方法回顾性分析自2018-01—2019-10采用后路椎管减压植骨融合内固定治疗的63例腰椎退行性疾病,31例术中局部应用氨甲环酸(观察组),32例术中使用生理盐水浸润纱布压迫止血和浸泡切口5 min(对照组)。比较两组手术时间、术中出血量、术后1 d引流量、术后1 d血红蛋白浓度(Hemoglobin,Hb)、术后总引流量以及术后1 d活化部分凝血酶原时间(Activated partial thromboplastin time,APTT)、凝血酶原时间(Prothrombin time,PT)、凝血酶时间(Thrombin time,TT)、纤维蛋白原浓度(Fibrinogen,FIB)。结果63例均顺利完成手术,随访时间3~6个月,平均4.5个月。术后切口均一期愈合,术后1个月内均未出现下肢深静脉血栓。两组手术时间、术中出血量比较差异无统计学意义(P>0.05)。两组术后1 d APTT、PT、TT、FIB比较差异无统计学意义(P>0.05)。观察组术后1 d引流量较对照组少,术后总引流量较对照组少,术后1 d Hb较对照组高,差异有统计学意义(P<0.05)。结论后路椎管减压植骨融合内固定术中局部应用氨甲环酸是安全、可行的,不会影响凝血功能,也不会增加下肢深静脉血栓形成的风险,同时可有效地减少术后引流量。Objective To analyze the hemostatic effect of topical application of tranexamic acid in posterior spinal canal decompression and bone grafting fusion internal fixation of lumbar degenerative diseases.Methods Sixty-three cases of lumbar degenerative diseases treated with posterior spinal canal decompression and bone grafting fusion internal fixation from January2018 to October 2019 were retrospectively analyzed,31 cases received topical application of tranexamic acid(observation group),and 32 cases used saline infiltrated gauze to compress the bleeding and soak the incision for 5 minutes(control group).The operation time,intraoperative blood loss,drainage volume on the first postoperative day,hemoglobin concentration(Hb)on the first postoperative day,total postoperative drainage volume,and activated partial prothrombin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen concentration(FIB)of the first postoperative day were compared between the two groups.Results All 63 cases were completed the operation successfully.The follow-up time was 3 to 6 months,with an average of 4.5 months.All incisions healed by primary intention,and no deep vein thrombosis of lower extremity occurred within the first month after operation.There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).There was no significant difference in APTT,PT,TT and FIB on the first day after operation between the two groups(P>0.05).The drainage volume on the first postoperative day of the observation group was less than that of the control group,the total postoperative drainage volume was less than that of the control group,and the Hb on the first postoperative day of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Topical application of tranexamic acid in posterior spinal canal decompression and bone grafting fusion internal fixation is safe and feasible.It will not affect coagulation function,nor increas

关 键 词：腰椎退行性疾病 后路椎管减压植骨融合内固定 氨甲环酸 术后引流量 手术安全性 

分 类 号：R681.5[医药卫生—骨科学]