股骨近端防旋髓内钉置入修复老年股骨转子间骨折围术期的止血与抗凝

文题释义：氨甲环酸：是一种氨基酸赖氨酸的合成衍生物，半衰期3 h，在纤溶酶原激活中起着竞争性抑制剂的作用。由于其作用于纤溶系统，止血效果显著，如今被认为是一种安全有效的可减少围术期失血的药物，被广泛应用于神经、心脏、脊柱矫形、关节置换及颌面部外科等手术中止血。利伐沙班：是首个上市的口服直接Xa因子抑制剂，药物相互作用少，无需常规监测凝血指标，在老年患者及骨科大手术的抗凝治疗中更具有优势。背景：目前世界上尚无老年股骨转子间骨折手术平衡止血和抗凝的共识及指南。将氨甲环酸与利伐沙班联合应用于老年股骨转子间骨折患者围术期止血与抗凝管理的相关文献较少。目的：观察氨甲环酸联合利伐沙班对老年股骨转子间骨折患者围术期出血、输血及术后静脉血栓形成的影响。方法：纳入老年股骨转子间骨折患者60例，计划行股骨防旋髓内钉手术治疗，所有入组的患者给予利伐沙班10 mg/d抗凝，直至手术前24 h。患者分2组，试验组30例术中静脉滴入1.0 g氨甲环酸，对照组例静脉滴入相同体积的葡萄糖溶液。收集两组手术失血量、输血及出院前静脉血栓形成情况进行比较。结果与结论：①试验组的失血量明显低于对照组(P < 0.05)。两组出院前静脉血栓形成无显著差异；②试验组中3例患者接受了输血，对照组7例患者接受了输血；③结果证实，氨甲环酸联合利伐沙班不仅可以减少老年股骨转子间骨折患者的围术期失血，而且不增加静脉血栓形成的风险。ORCID: 0000-0001-6249-9714(王海滨)中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Hemostatic and anticoagulant effects of proximal femoral nail anti-rotation in repairing elderly patients with intertrochanteric fractures during perioperative period

BACKGROUND:At present,there is no consensus and guideline for balanced hemostasis and anticoagulation in elderly patients with intertrochanteric fractures.There are few related literatures on the perioperative hemostasis and anticoagulation management of tranexamic acid combined with rivaroxaban in elderly patients with intertrochanteric fractures.OBJECTIVE:To investigate the effects of tranexamic acid combined with rivaroxaban on perioperative hemorrhage,blood transfusion,postoperative venous thrombosis in elderly patients with intertrochanteric fractures.METHODS:Sixty elderly patients with intertrochanteric fractures were enrolled and scheduled to undergo proximal femoral nail anti-rotation surgery.All patients received rivaroxaban 10 mg/d anticoagulant until 24 hours before operation.All patients were divided into two groups.Patients in the test group were intravenously injected with 1.0 g of tranexamic acid.Patients in the control group were intravenously injected with the same volume of glucose solution.Surgical blood loss,blood transfusion,and venous thrombosis prior to discharge were compared in the two groups.RESULTS AND CONCLUSION:(1)The blood loss in the test group was significantly lower than that in the control group(P<0.05).There was no significant difference in venous thrombosis before discharge between the two groups.(2)Three patients in the test group received blood transfusions,and seven patients in the control group received blood transfusions.(3)The results confirm that tranexamic acid combined with rivaroxaban not only reduces perioperative blood loss in elderly patients with intertrochanteric fractures,but also does not increase the risk of venous thrombosis.