可注射止血明胶与局部应用氨甲环酸对兔股骨髓内钉内固定术后髓内止血效果的比较  

Comparative study of the hemostatic effects of injectable hemostatic gelatin and local application of tranexamic acid on rabbit femoral intramedullary internal fixation

作　　者：李波 张浩然 卑明健 吴新宝 杨明辉 LI Bo;ZHANG Haoran;BEI Mingjian;WU Xinbao;YANG Minghui(Department of Orthopaedics&Traumatology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院创伤骨科,北京100035

出　　处：《中华骨与关节外科杂志》2025年第4期357-361,共5页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金(82172434);北京市医院管理中心2023年度“青苗”计划(QMS20230401);2023年度首都医科大学优秀青年人才项目(B2309);2022年北京积水潭医院“科研优才”计划(JSTYC202205);北京积水潭医院“学科新星”计划(XKXX202116)。

摘　　要：目的:比较可注射止血明胶与局部应用氨甲环酸对兔股骨髓内钉内固定术后髓内止血的效果。方法:8只成年雌性新西兰大白兔,随机分为Surgiflo组和氨甲环酸组,每组各4只。构建股骨逆行性髓内钉内固定术动物模型模拟股骨髓腔出血的情况。经股骨远端髓腔开口、扩髓后,Surgiflo组实验动物髓腔内注入可注射止血明胶Surgiflo,氨甲环酸组实验动物髓腔内注入氨甲环酸溶液,随后两组实验动物均植入合适长度的钛合金针。观察并记录髓内钉入口处的出血量,术前及术后第1、3、7日分别采血进行血常规检查以明确血红蛋白水平的变化。结果:两组实验动物术前体重差异无统计学意义(P>0.05)。Surgiflo组实验动物在注入止血明胶及髓内钉植入后即刻即显示出止血效果,而氨甲环酸组实验动物在注入氨甲环酸溶液及髓内钉植入后仍可见髓腔开口处持续有血液渗出,观察的10 min内,氨甲环酸组实验动物髓腔失血量多于Surgiflo组实验动物[2.16(1.05,4.79)g vs.0.01(0.01,0.02)g],且差异有统计学意义(P<0.05)。术前及术后第1、3、7日两组实验动物血红蛋白水平差异均无统计学意义(P均>0.05)。结论:在兔股骨逆行性髓内钉内固定术模型中,相较于氨甲环酸,可注射止血明胶可能具有更优的髓内止血效果。Objective:To compare the hemostatic effects of injectable hemostatic gelatin and local application of tranexamic acid on femoral intramedullary nailing internal fixation in rabbits.Methods:Eight adult female New Zealand white rabbits were randomly divided into two groups:the Surgiflo group and the tranexamic acid group,with four rabbits in each group.An animal model of femoral retrograde intramedullary nailing internal fixation was established to simulate bleeding in the femoral medullary cavity.After opening and expanding the medullary cavity through the distal femur,the medullary cavity of experimental animals in the Surgiflo group was injected with hemostatic gelatin(Surgiflo),and the tranexamic acid group was injected with tranexamic acid solution.Titanium alloy nails of appropriate length were then implanted in both groups.Bleeding at the entrance of the intramedullary nail was observed and recorded.Blood samples were collected for routine testing before surgery and on the 1st,3rd,and 7th days after surgery to determine changes in hemoglobin levels.Results:There was no significant difference in body weight between the two groups.Animals in the Surgiflo group showed immediate hemostatic effects after the application of hemostatic gelatin and implantation of the intramedullary nail.In contrast,the tranexamic acid group still exhibited continuous bleeding at the medullary cavity opening after the application of tranexamic acid and the implantation of the intramedullary nail.During the 10-minute observation period,the tranexamic acid group had greater blood loss in the medullary cavity than the Surgiflo group(0.01[0.01,0.02]g vs.2.16[1.05,4.79]g,P<0.05).There was no significant difference in hemoglobin levels between the two groups before surgery and on the 1 st,3 rd,and 7 th days after surgery(all P>0.05).Conclusions:In the rabbit femoral retrograde intramedullary nailing fixation model,injectable hemostatic gelatin appears to provide a better intramedullary hemostatic effect compared to tranexamic acid.

关 键 词：股骨 髓内钉 止血 可注射止血明胶 氨甲环酸 

分 类 号：R683[医药卫生—骨科学]