氨甲环酸减少老年股骨转子间骨折APFNA术后隐性失血的随机对照研究

目的研究氨甲环酸对减少老年股骨转子间骨折采用亚洲型股骨近端防旋髓内钉(Asia proximal femoral nail antirotation,APFNA)内固定术后隐性失血的作用及相关并发症。方法采用随机对照研究,连续纳入2017年4月至2018年8月期间北京市通州区中西医结合医院骨科80例老年转子间骨折APFNA内固定患者,采用随机数字表法随机分为两组,使用氨甲环酸组为观察组,不使用氨甲环酸组为对照组。观察组患者共40例,其中男11例,女29例;年龄65~91岁,平均(76.15±7.55)岁。观察组患者在术中切皮的同时应用1 g氨甲环酸加入250 mL 0.9%氯化钠注射液中缓慢静滴。对照组患者共40例,其中男13例,女27例;年龄65~91岁,平均(76.28±7.57)岁。对照组患者在术中切皮的同时应用250 mL 0.9%氯化钠注射液缓慢静滴。观察两组患者性别、身高、体重、手术时间、手术前后红细胞压积(hematocrit,Hct)、术中及术后失血量,并在术后10d行双下肢静脉彩超检查明确有无血栓。结果总失血量:观察组平均为(681.29±148.04)mL,对照组平均为(973.85±186.50)mL,组间比较差异有统计学意义(P<0.05);隐性失血量:观察组平均为(529.79±56.10)mL,对照组平均为(817.35±92.89)mL,组间比较差异有统计学意义(P<0.05);显性失血:观察组平均为(151.50±93.80)mL,对照组平均为(156.50±95.15)mL,组间比较差异无统计学意义(P>0.05);两组均无血栓形成的病例。输血情况:观察组有5例(12.50%)接受输血治疗,平均输血量1.40 U;对照组有13例(32.50%,13/40)接受输血治疗,平均2.55U。输血率组间比较差异有统计学意义(P=0.033),平均输血量组间比较差异无统计学意义(P>0.05)。结论老年股骨转子间骨折内固定手术后隐性失血占总失血量的很大比重,接近85%,应用氨甲环酸可以有效减少老年股骨转子间骨折APFNA内固定术后总失血量和隐性失血量,其中隐性失血量可降低约35%,且并未显著增加DVT的发生率,具有较高的安全性和较好的可操作性。

Clinical Study of Tranexamic Acid in Reducing Recessive Blood Loss in Eelderly Patients with Intertrochanteric Fracture after APFNA Operation:A Randomized Controlled Study

Objective To assess the impact of tranexamine acid on the hidden blood loss in intertrochanteric fractures treated with Asia proximal femoral nail anti-rotation(APFNA)and related complications.Methods A randomized controlled study was used.A total of 80 elderly patients with APFNA internal fixation for intertrochanteric fractures in the Department of Orthopedics of Tongzhou District Hospitalin Beijing from April 2017 to August 2018 were included and randomly divided into two groups by random number table method.The observation group was treated with tranexamic acid and the control group with or without tranexamic acid.In the observation group,there were a total of 40 patients,including 11 males and 29 females,the average age was(76.15±7.55)years(65~91 years).Patients in the observation group were treated with 1g tranexamic acid added to 250 mL 0.9%sodium chloride injection while undergoing intraoperative dermectomy.A total of 40 patients were included in the control group,including 13 males and 27 females,the average age was(76.28±7.57)years(65~91 years).Patients in the control group were treated with 250 mL 0.9%sodium chloride injection by slow intravenous drip.Gender,height,weight,operation time,RBC hematocrit before and after operation,intraoperative and postoperative blood loss were observed in the 2 groups.Color ultrasound examination of lower limb veins was performed 10 days after operation to determine whether there was thrombosis.Results The total blood loss was(681.29±148.04)mL in the observation group and(973.85±186.50)mL in the control group.There was statistically significant difference(P<0.05).The average invisible blood losswas(529.79±56.10)mL in the observation group and(817.35±92.89)mL in the control group,and the difference was statistically significant(P<0.05).The average dominant blood losswas(151.50±93.80)mL in the observation group and(156.50±95.15)mL in the control group,and the difference was not statistically significant(P>0.05).There were no cases of thrombosis in either group.5 patients(12.50%)in the observation group received blood transfusion,with an average transfusion volume of 1.40 U.In the control group,13 patients(32.50%,13/40)received blood transfusion,with an average of 2.55 U.The difference in blood transfusion rate between groups was statistically significant(P=0.033),while the difference in average blood transfusion volume between groups was not statistically significant(P>0.05).Conclusion After the treatment of intertrochanteric fractures with APFNA,hidden blood lossis a large proportion of total blood loss,close to 85%,the application of tranexamic acid can effectively reduce the elderly intertrochanteric fracture with APFNA both total blood loss and hidden blood loss,postoperative of hidden blood loss can reduce about 35%,and did not significantly increase the incidence of DVT.The treatment has high security and good operability.