中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (22): 3550-3554.doi: 10.12307/2023.366

• 骨科植入物 orthopedic implant • 上一篇    下一篇

老年股骨转子间骨折治疗过程中氨甲环酸的应用

邱  皓，朱  云，翁  政，刘  盾，陈诗谋，靳国荣，陈  渝   

  1. 重庆市第九人民医院创伤中心(骨科病区)，重庆市   400700
  • 收稿日期:2022-05-11 接受日期:2022-06-25 出版日期:2023-08-08 发布日期:2022-11-02
  • 通讯作者: 陈渝，博士，主任医师，重庆市第九人民医院创伤中心(骨科病区)，重庆市 400700
  • 作者简介:邱皓，男，1991年生，重庆市人，汉族，2017年重庆医科大学毕业，硕士，主治医师，主要从事创伤骨科方面的研究。
  • 基金资助:
    重庆市第九人民医院院级课题(2020YJXM10)，项目负责人：邱皓；重庆市北碚区科学技术局专项课题(2021-32)，项目负责人：陈渝

Application of tranexamic acid in elderly patients with femoral intertrochanteric fracture

Qiu Hao, Zhu Yun, Weng Zheng, Liu Dun, Chen Shimou, Jin Guorong, Chen Yu   

  1. Center for Traumatology, Ninth People’s Hospital of Chongqing, Chongqing 400700, China
  • Received:2022-05-11 Accepted:2022-06-25 Online:2023-08-08 Published:2022-11-02
  • Contact: Chen Yu, MD, Chief physician, Center for Traumatology, Ninth People’s Hospital of Chongqing, Chongqing 400700, China
  • About author:Qiu Hao, Master, Attending physician, Center for Traumatology, Ninth People’s Hospital of Chongqing, Chongqing 400700, China
  • Supported by:
    Hospital Level Project of Chongqing Ninth People’s Hospital, No. 2020YJXM10 (to QH); Special Project of Science and Technology Bureau of Beibei District of Chongqing, No. 2021-32 (to CY)

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摘要：


文题释义：

股骨转子间骨折：多为间接暴力所致。往往是人摔倒后髋部着地发生，也可因跌倒时下肢突然扭转所致，常见于老年人。在发生转子间骨折以后，通常患肢是处于外展外旋位，同时髋部会有疼痛和肿胀。对于转子间骨折可进行骨折的卧床牵引治疗和手术治疗，目前最主要的治疗方式为手术治疗。
氨甲环酸：属抗纤维蛋白溶解剂，为一种人工合成的赖氨酸衍生物，它通过结合血纤维蛋白溶解分子上的赖氨酸结合位点，竞争性抑制纤维酶原在纤维蛋白上吸附，以阻止纤维酶原激活，导致纤溶酶不能降解纤维蛋白，以达到止血效果及抗纤溶作用。

背景：研究显示，氨甲环酸可减少全髋及全膝关节置换患者失血量，降低输血率，且不影响凝血功能，不会使下肢深静脉血栓发生的风险增加。然而氨甲环酸应用于老年股骨转子间骨折手术中的研究较少，目前尚缺乏可靠的临床数据支持。
目的：探讨氨甲环酸应用于老年人股骨转子间骨折行新型股骨近端髓内钉手术中的有效性及安全性。
方法：纳入重庆市第九人民医院2021年1月至2022年4月期间收治的符合纳入标准的股骨转子间骨折患者共50例，将研究对象按照随机数表法分为2组，实验组将氨甲环酸1 g加入100 mL生理盐水，于术前15 min静脉滴注；对照组于术前15 min静脉滴注100 mL生理盐水。记录两组手术时间、术中失血量、术后引流量、输血情况；检测术前及术后第3天血红蛋白、红细胞压积、纤维蛋白水平；检测术后第3天及1，3，6周血栓情况。
结果与结论：①两组患者手术时间、术前的血红蛋白、红细胞压积、术前及术后纤维蛋白等指标比较差异无显著性意义(P > 0.05)，对照组术后的血红蛋白、红细胞压积明显低于实验组(P < 0.05)；②实验组术中失血量、术后引流量、隐性失血量、总失血量均少于对照组(P < 0.05)；③两组患者在血栓事件上比较差异无显著性意义(P > 0.05)，而在输血事件上实验组明显低于对照组(P < 0.05)；④结果表明，在老年股骨转子间骨折行新型股骨近端髓内钉内固定的患者中应用氨甲环酸能够减少术中失血量、术后引流量及隐性失血量，降低围术期总失血量，减少输血率，增加术后血红蛋白及红细胞压积，而不会增加血栓栓塞事件形成的风险及对纤维蛋白的影响。

https://orcid.org/0000-0001-6301-4790 (邱皓) 

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

关键词: 老年人, 股骨转子间骨折, 新型股骨近端髓内钉(TFNA), 氨甲环酸, 疗效分析

Abstract: BACKGROUND: Studies have shown that tranexamic acid can reduce blood loss in patients with total hip and total knee replacement, reduce blood transfusion rate, and does not affect coagulation function, and does not increase the risk of lower extremity deep vein thrombosis. However, there are few studies on the application of tranexamic acid in elderly intertrochanteric fracture surgery, and there is still a lack of reliable clinical data to support it.  
OBJECTIVE: To investigate the efficacy and safety of tranexamic acid in trochanteric fixation nail-advanced for femoral intertrochanteric fracture in the elderly.
METHODS: A total of 50 patients who met the inclusion criteria and were included in Chongqing Ninth People’s Hospital from January 2021 to April 2022 were enrolled in this study. The subjects were divided into two groups according to the random number table method. In the experimental group, 1 g of tranexamic acid was added into 100 mL normal saline and drip intravenously 15 minutes before operation. In the control group, 100 mL normal saline was drip intravenously 15 minutes before operation. The operation time, intraoperative blood loss, postoperative drainage, blood transfusion, hemoglobin, hematocrit, fibrin (before and on the third day after operation), and thrombosis (at 3 days, 1, 3 and 6 weeks after operation) were recorded in both groups.  
RESULTS AND CONCLUSION: (1) There was no significant difference in operation time, preoperative hemoglobin, hematocrit, preoperative and postoperative fibrin between the two groups (P > 0.05). The postoperative hemoglobin and hematocrit in the control group were significantly lower than those in the experimental group (P < 0.05). (2) The intraoperative blood loss, postoperative drainage volume, hidden blood loss and total blood loss in the experimental group were less than those in the control group (P < 0.05). (3) There was no significant difference in thrombotic events between the two groups (P > 0.05). The blood transfusion events in the experimental group were significantly lower than those in the control group (P < 0.05). (4) In the elderly patients with femoral intertrochanteric fracture undergoing trochanteric fixation nail-advanced surgery, the application of tranexamic acid can reduce the intraoperative blood loss, postoperative drainage volume and hidden blood loss, reduce the total perioperative blood loss, reduce the blood transfusion rate, and increase the postoperative hemoglobin and hematocrit, without increasing the risk of thromboembolic events and the impact on fibrin.

Key words: old people, fermoral intertrochanteric fracture, trochanteric fixation nail-advanced, tranexamic acid, curative effect analysis

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