切口内使用氨甲环酸对早期手术治疗伴神经损伤的胸腰椎爆裂骨折失血量的影响

目的探讨切口内使用氨甲环酸(TXA)对早期手术治疗伴神经损伤的胸腰椎爆裂骨折(TBF)患者的安全性和有效性。方法前瞻性纳入2015年6月—2019年6月重庆医科大学附属第一医院收治的伴神经损伤TBF患者59例,男性34例,女性25例;年龄35~63岁,平均46.9岁。患者均接受后路减压骨折复位内固定术,使用随机数字表法分为TXA组(30例)和生理盐水组(29例)。在切皮暴露后30例患者切口处浸泡100mL TXA溶液(1g)5min(TXA组);29例患者浸泡相同体积生理盐水5min(生理盐水组)。收集两组患者一般资料、总失血量、显性失血量、隐性失血量、术中失血量及引流量;同时检测患者术前,术后第1、3天红细胞浓度(Hgb)及红细胞压积(Hct),并记录每组输血例数、下地时间、住院时间及药物相关并发症。结果TXA组手术时间较生理盐水组显著减少(110.67±12.95)min vs.(135.14±15.68)min,P<0.05。失血量分析发现TXA组术后总失血量(942.11±49.03)mL vs.(1192.20±51.94)mL、显性失血量(514.92±68.54)mL vs.(754.57±59.43)mL、术中失血量(250.45±60.35)mL vs.(364.73±52.17)mL及术后引流量(170.46±25.04)mL vs.(312.36±46.53)mL均较生理盐水组显著降低(P<0.05),但两组患者隐性失血量(428.19±35.44)mL vs.(437.63±39.28)mL差异无统计学意义(P>0.05)。术后第1、3天TXA组Hgb(123.51±10.36)g/L、(120.39±12.35)g/L显著高于生理盐水组(109.43±11.69)g/L、(107.59±9.38)g/L,因此输血例数TXA组显著减少(1/30 vs.5/29)(P<0.05),但两组患者Hct差异无统计学意义(36.04±5.39)%vs.(36.18±5.57)%、(35.86±4.43)%vs.(35.91±4.69)%,P>0.05。同时,TXA组下地时间、住院时间(2.31±0.79)d、(5.43±1.48)d较生理盐水组(4.45±1.24)d、(8.15±2.05)d显著缩短(P<0.05),两组患者均未发现药物相关不良反应。结论本研究初步证实切口内使用TXA对于伴神经损伤TBF早期手术患者具有良好的安全性与有效性。

The influence of topical use of tranexamic acid in reducing blood loss on early operation for thoracolumbar burst fracture with neurological deficit

Objective To investigate the safety and efficacy of topical use of tranexamic acid(TXA)on early operation for thoracolumbar burst fracture(TBF)with neurological deficit.Methods From Jun.2015 to Jun.2019,59 patients with TBF with neurological deficit from the Department of Orthopedics in the First Affiliated Hospital of Chongqing Medical University were prospectively enrolled.There were 34 males and 25 females with an average age of 46.9(35-63)years.All the patients received the operation of posterior open reduction,fracture decompression and internal fixation.After opening the incision,30 paients'wound surface was soaked with TXA(1g in 100 mL saline solution)for 5 minutes(TXA group);29 paients'wound surface was soaked with the same volume of normal saline(normal saline group).The base line information,operation time,total blood loss,visible blood loss,hidden blood loss,intraoperative blood loss,and postoperative drainage were recorded;the preoperative and postoperative hemoglobin(Hgb)concentration and hematocrit(HCT)were measured;at the same time,blood transfusion cases,the time of hopitalization and ambulation,and drug-related complications were also recorded.Results The operation time was significantly decreased in the TXA group[(110.67±12.95)min vs.(135.14±15.68)min,P<0.05].The results of blood loss analysis showed that the total blood loss[(942.11±49.03)mL vs.(1192.20±51.94)mL],visible blood loss[(514.92±68.54)mL vs.(754.57±59.43)mL],intraoperative blood loss[(250.45±60.35)mL vs.(364.73±52.17)mL],and postoperative drainage[(170.46±25.04)mL vs.(312.36±46.53)mL]were obviously lower in the TXA group compared with those in the normal saline group(P<0.05),but the hidden blood loss[(428.19±35.44)mL vs.(437.63±39.28)mL]showed no statistic difference between the two groups(P>0.05).The blood routine examination at the first and third day postoperatively indicated that the Hgb concentration in the TXA group[(123.51±10.36)g/L,(120.39±12.35)g/L]was significantly higher than that in the normal saline group[(109.43±11.69)g/L,(107.59±9.38)g/L],leading to less blood transfusion cases(1/30 vs.5/29,P<0.05).However,the HCT level was similar in both groups at the first and third day[(36.04±5.39)%vs.(36.18±5.57)%,(35.86±4.43)%vs.(35.91±4.69)%,P>0.05].Meanwhile,the time of hopitalization and ambulation was shortened in the TXA group[(2.31±0.79)d,(5.43±1.48)d vs.(4.45±1.24)d,(8.15±2.05)d,P<0.05],and drug-related complications were not recorded in either group.Conclusion This study preliminarily suggested that topical use of tranexamic acid on early operation for TBF with neurological deficit is safe and effective,which is worthy wide application in future clinical practice.