切换至 "中华医学电子期刊资源库"
高级检索
中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2019, Vol. 05 ›› Issue (04) : 201 -205. doi: 10.3877/cma.j.issn.2096-0263.2019.04.004

所属专题： 文献；

髋部骨折

氨甲环酸局部应用并不放置引流对高龄人工股骨头置换术失血量的影响
段国庆1, 宋世强1, 张元民1,†()   
  1. 1. 272029　济宁医学院附属医院骨关节科
  • 收稿日期:2019-02-06 出版日期:2019-08-05
  • 通信作者: 张元民
  • 基金资助:
    济宁医学院青年教师科研扶持基金(JY2017FS012)

Effect of local application of tranexamic acid without drainage on blood loss in elderly patients with hip hemiarthroplasty

Guoqing Duan1, Shiqiang Song1, Yuanmin Zhang1,†()   

  1. 1. Department of Bone and Joint Surgery, Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2019-02-06 Published:2019-08-05
  • Corresponding author: Yuanmin Zhang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

段国庆, 宋世强, 张元民. 氨甲环酸局部应用并不放置引流对高龄人工股骨头置换术失血量的影响[J]. 中华老年骨科与康复电子杂志, 2019, 05(04): 201-205.

Guoqing Duan, Shiqiang Song, Yuanmin Zhang. Effect of local application of tranexamic acid without drainage on blood loss in elderly patients with hip hemiarthroplasty[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2019, 05(04): 201-205.

目的

探讨氨甲环酸局部应用并不放置引流对高龄人工股骨头置换术患者失血量的影响。

方法

回顾性收集济宁医学院附属医院骨关节科收治的50例因股骨颈骨折行人工股骨头置换术的高龄患者，随机分为试验组和对照组，每组各25例。试验组在缝合阔筋膜张肌后关节腔注射2 g氨甲环酸，并加入生理盐水稀释至50 ml；对照组则关节腔注射50 ml生理盐水，2组术后均不放置引流。比较两组患者术中显性失血量、术后隐性失血量、总失血量、输血率、术后第1、3、5天血红蛋白以及下肢深静脉血栓、肺栓塞、切口感染等并发症的发生率。

结果

试验组第1、3、5天血红蛋白浓度高于对照组（t=7.473, t=7.226, t=7.572, P<0.05），其总失血量、显性失血量、隐性失血量及输血率低于对照组，差异有统计学意义（t=7.881, t=15.353, t=7.225, t=5.781，P<0.05）。两组患者术中出血量差异比较无统计学意义（t=1.382，P>0.05）。两组患者均无下肢深静脉血栓形成及肺栓塞发生。两组患者均有1例发生下肢肌间静脉血栓，无统计学差异。两组患者术后3 h相关凝血指标比较差异无统计学意义（t=1.483, t=1.352, t=1.466，P>0.05）。

结论

人工股骨头置换术中关节腔注射氨甲环酸并不放置引流，能有效减少术后失血和输血，不增加下肢深静脉血栓形成和肺栓塞的发生，对凝血无影响。

关键词: 股骨颈骨折, 关节成形术，置换，髋, 氨甲环酸, 失血，手术, 静脉血栓形成
Objective

To explore the effect of local application of tranexamic acid (TXA) without drainage on blood loss in elderly patients with hip hemiarthroplasty.

Methods

A retrospective study was performed in 50 elderly cases of femoral neck fractures who had underwent hip hemiarthroplasty in department of Bone and Joint Surgery of Affiliated Hospital of Jining Medical University. Patients were randomly divided into the TXA group (n=25) and the control group (n=25). The TXA group received the intra-articular injection of 2 g TXA dissolved in 50 ml of normal saline, the control group received the intra-articular injection of the same volume of normal saline before closing the incision. The drainage tube was not used in both groups. The intraoperative blood loss, external blood loss, hidden blood loss, total blood loss, transfusion rate, postoperative hemoglobin concentration and complications were compared between the two groups.

Results

The postoperative hemoglobin concentrations in the TXA group were higher than those in the control group (t=7.473, t=7.226, t=7.572, P<0.05). The total blood loss, external blood loss, hidden blood loss and blood transfusion rate were lower than those in the control group (t=7.881, t=15.353, t=7.225, t=5.781, P<0.05). There were no significant difference in the intraoperative blood loss and postoperative 3-hour-related blood coagulation indexes between the two groups (t=1.382, P<0.05). No deep vein thrombosis and pulmonary embolism occurred in the two groups. Each group had 1 case of intermuscular venous thrombosis, there was no significant difference between the two groups. There was no significant difference in the coagulation parameters between the two groups at 3 h after surgery (t=1.483, t=1.352, t=1.466, P>0.05).

Conclusion

Local application of tranexamic acid (TXA) without drainage can effectively reduce perioperative blood loss and transfusion rate, and does not increase the incidence of complications in the elderly patients with hip hemiarthroplasty.

Key words: Femoral neck fractures, Arthroplasty, replacement, hip, Tranexamic acid, Blood loss, sugical, Venous thrombosis
表1 两组高龄人工股骨头置换患者术前一般资料比较
组别 性别（例，男/女） 年龄（岁，±s） BMI（kg/m2，±s） 病程（年，±s） 纤维蛋白原（g/L，±s） 凝血酶原时间（s，±s） 活化部分凝血活酶时间（s，±s）
试验组 8/17 80.9±5.3 24.3±3.8 107.6±5.3 2.8±0.3 12.5±1.2 35.7±1.1
对照组 9/16 81.3±5.7 25.1±4.2 109.1±6.5 2.9±0.5 11.8±0.9 36.2±1.7
统计值 χ2=0.256 t=0.245 t=1.145 t=0.561 t=0.863 t=0.475 t=0.539
P值 0.694 0.796 0.259 0.557 0.492 0.136 0.118
表2 两组高龄人工股骨头置换患者术后血红蛋白水平及输血率比较
组别 例数 血红蛋白（±s，g/L） 输血率（%）
术后第1天 术后第3天 术后第5天
试验组 25 100.3±6.5 93.6±8.4 95.5±4.6 1（4%）
对照组 25 92.7±3.8 85.3±5.7 87.2±5.1 4（16）
统计值   t=7.473 t=7.226 t=7.572 χ2=5.781
P值   <0.05 <0.05 <0.05 <0.05
表3 两组高龄人工股骨头置换患者失血量比较（±s，ml）
组别 例数 术中失血量 术后显性失血量 隐性失血量 总失血量
试验组 25 148.8±49.3 22.5±5.8 135.6±22.5 300.8±55.3
对照组 25 150.3±50.2 50.6±8.4 188.3±39.4 392.6±46.9
t值   1.382 15.353 7.225 7.881
P值   5.271 <0.01 0.028 0.016
表4 两组高龄人工股骨头置换患者术后相关凝血指标比较（±s）
组别 例数 纤维蛋白原（g/L） 凝血酶原时间（s） 部分活化凝血活酶时间（s）
试验组 25 3.62±4.3 13.6±2.9 38.4±5.3
对照组 25 3.58±3.8 12.9±2.1 38.8±4.8
t值   1.483 1.352 1.466
P值   4.772 5.128 5.217
1
Seo JG, Moon YW, Park SH, et al. The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty [J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(8): 1869-1874.
2
Wind TC, Barfield WR, Moskal JT. The effect of tranexamic acid on transfusion rate in primary total hip arthroplasty [J]. J Arthroplasty, 2014, 29(2): 387-389.
3
赵良军,劳山,赵劲民,等.局部应用氨甲环酸对全髋关节置换术围手术期隐性失血的影响[J].中华创伤骨科杂志, 2016, 18 (11):945-949.
4
Travis EC, Tan RS, Funaki P, et al.Clinical outcomes of total hip arthroplasty for fractured neck of femur in patients over 75 years[J]. J Arthroplasty, 2015, 30 (2):230-234.
5
Meessen JM, Pisani S, Gambino ML, et al. Assessment of mortality risk in elderly patients after proximal femoral fracture[J]. Orthopedics, 2014, 37 (2):194-200.
6
Florschutz AV, Langford JR, Haidukewych GJ, et al. Femoral neck fractures:current management[J].J Orthop Trauma, 2015, 29 (3):121-129.
7
Tosounidis T, Aderinto J, Giannoudis PV. Pipkin type-III fracture of the femoral head:Fix it or replace it[J].Injury,2017,48(11):2375-2378.
8
段国庆，任春凤.不同剂量氨甲环酸局部应用并不放置引流减少全膝关节置换后失血[J].中国组织工程研究，2017,21(35):5583-5588.
9
Aydın BK, Durgut F, Erkoçak ÖF, et al. Other benefits of intra-articular injection of tranexamic acid in primary total knee arthroplasty apart from reducing blood transfusion rates [J]. Eklem Hastalik Cerrahisi, 2017, 28(1): 25-29.
10
Ralley FE, Berta D, Binns V, et al. One intraoperative dose of tranexamic acid for patients having primary hip or knee arthroplasty [J]. Clin Orthop Relat Res, 2010, 468(7): 1905-1911.
11
Alshryda S, Sukeik M, Sarda P, et al. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement [J]. Bone Joint J, 2014, 96-B(8): 1005-1015.
12
Zhang Y, Zhang JW, Wang BH. Efficacy of tranexamic acid plus drain-clamping to reduce blood loss in total knee arthroplasty: A meta-analysis [J]. Medicine, 2017, 96(26): e7363.
13
Hynes M, Calder P, Scott G. The use of tranexamic acid to reduce blood loss during total knee arthroplasty [J]. Knee, 2003, 10(4): 375-377.
14
Zhao-Yu C, Yan G, Wei C, et al. Reduced blood loss after intra-articular tranexamic acid injection during total knee arthroplasty: a meta-analysis of the literature [J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(12): 3181-3190.
15
Goyal N, Chen DB, Harris IA, et al. Intravenous vs Intra-Articular tranexamic acid in total knee arthroplasty: a randomized, Double-Blind trial [J]. J Arthroplasty, 2017, 32(1): 28-32.
16
Hamlin BR, Digioia AM, Plakseychuk AY, et al. Topical versus intravenous tranexamic acid in total knee arthroplasty [J]. J Arthroplasty, 2015, 30(3): 384-386.
[1] 金鑫, 谢卯, 刘芸, 杨操, 杨述华, 许伟华. 个性化股骨导向器辅助初次全髋关节置换的随机对照研究[J]. 中华关节外科杂志(电子版), 2023, 17(06): 780-787.
[2] 邓华梅, 袁札根, 曾德荣, 潘珊珊, 张葆青, 欧爱华, 曹学伟. 全膝关节置换术中气压止血带应用效果与影响因素分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 788-794.
[3] 孟繁宇, 周新社, 赵志, 裴立家, 刘犇. 侧位直接前方入路髋关节置换治疗偏瘫肢体股骨颈骨折[J]. 中华关节外科杂志(电子版), 2023, 17(06): 865-870.
[4] 肖志满, 龚煜, 谢景凌, 刘斌伟. 上下肢关节镜手术后患者下肢深静脉血栓发生的对比研究[J]. 中华关节外科杂志(电子版), 2023, 17(05): 601-606.
[5] 邵长杰, 杜晓颖, 徐奎帅, 张靓, 纪岩磊. 住院天数影响全膝关节置换术后下肢深静脉血栓形成[J]. 中华关节外科杂志(电子版), 2023, 17(04): 588-591.
[6] 张程, 何海军, 张光熠, 熊冰朗, 田天照, 孙诗艺, 吴子轩. 抗凝剂预防膝关节镜术后血栓发生的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(03): 340-347.
[7] 王波, 许珂, 刘林, 张斌飞, 庄岩, 许鹏. 全髋关节置换术在老年髋臼骨折中的应用[J]. 中华关节外科杂志(电子版), 2023, 17(03): 385-390.
[8] 王博永, 张飞洋, 沈灏. 全髋关节置换术后假体周围骨折研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(03): 391-397.
[9] 皮颖, 王高, 张强, 黄志荣. 年轻患者初次髋关节置换术后关节翻修的原因分析[J]. 中华关节外科杂志(电子版), 2023, 17(03): 430-434.
[10] 黄应雄, 叶子, 蒋鹏, 詹红, 姚陈, 崔冀. 急性肠系膜静脉血栓形成致透壁性肠坏死的临床危险因素分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 413-421.
[11] 金宇杰, 虞宵, 周晓强, 李志强, 徐人杰, 张向鑫, 陈广祥. 动力交叉钉系统治疗股骨颈骨折其内固定位置与临床疗效的相关性研究[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 193-200.
[12] 宋晓亮, 郝海虎, 刘渊, 李浩江, 雷晓晶, 邵新中, 李卿源. 股骨重建钉治疗股骨颈骨折的疗效观察[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 201-208.
[13] 宋碧萱, 郭海川, 韩子钰, 周瑞娟, 李承思, 姬晨妮. 开放式楔形胫骨高位截骨术后下肢深静脉血栓形成的危险因素分析及预测列线图的构建[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 226-232.
[14] 郑景达, 黄金旗, 张庆贤, 陈煌, 高晓杰. 小腿深静脉入路AngioJet一站式血栓清除治疗全肢型急性下肢深静脉血栓形成患者的临床研究[J]. 中华介入放射学电子杂志, 2023, 11(04): 305-309.
[15] 张德伟, 雷毅, 江哲宇, 王黎洲, 许国辉, 周石. 杂交手术治疗下肢深静脉血栓合并下肢急性动脉血栓一例[J]. 中华介入放射学电子杂志, 2023, 11(04): 380-384.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号