中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (9): 1381-1386.doi: 10.3969/j.issn.2095-4344.3756

• 人工假体Artificial prosthesis • 上一篇    下一篇

局部应用氨甲环酸减少老年股骨颈骨折全髋关节置换后引流的安全和有效性

张  冲,刘志昂,姚帅辉,高军胜,姜  岩,张  陆   

  1. 郑州人民医院骨二科,河南省郑州市   450000
  • 收稿日期:2020-03-26 修回日期:2020-04-01 接受日期:2020-05-16 出版日期:2021-03-28 发布日期:2020-12-15
  • 通讯作者: 张陆,主任医师,郑州人民医院骨二科,河南省郑州市 450000
  • 作者简介:张冲,男,1982年生,河南省襄城县人,汉族,硕士,主治医师,主要从事骨科研究。
  • 基金资助:
    河南省科技攻关项目基金(172102310525)

Safety and effectiveness of topical application of tranexamic acid to reduce drainage of elderly femoral neck fractures after total hip arthroplasty

Zhang Chong, Liu Zhiang, Yao Shuaihui, Gao Junsheng, Jiang Yan, Zhang Lu   

  1. Second Department of Orthopedics, Zhengzhou People’s Hospital, Zhengzhou 450000, Henan Province, China
  • Received:2020-03-26 Revised:2020-04-01 Accepted:2020-05-16 Online:2021-03-28 Published:2020-12-15
  • Contact: Zhang Lu, Chief physician, Second Department of Orthopedics, Zhengzhou People’s Hospital, Zhengzhou 450000, Henan Province, China
  • About author:Zhang Chong, Master, Attending physician, Second Department of Orthopedics, Zhengzhou People’s Hospital, Zhengzhou 450000, Henan Province, China
  • Supported by:
    the Science and Technology Research Project Fund of Henan Province, No. 172102310525

摘要:

文题释义:
氨甲环酸:是一种赖氨酸合成衍生物,可结合纤溶酶和纤溶酶原上的纤维蛋白亲和部位的赖氨酸结合部位,通过阻止纤溶酶、纤溶酶原与纤维蛋白结合抑制了纤溶酶介导的纤维蛋白分解,导致纤溶活性不足而达到减少术后出血。目前,关于氨甲环酸在骨科围术期的应用主要有全身应用与局部应用2种。
全髋关节置换:是治疗老年股骨颈骨折、髋关节骨性关节炎等的有效治疗方法,可恢复患者髋关节的部分功能,促进患者早日进行日常工作,改善患者的生活质量等,目前该术式已成为治疗老年股骨颈骨折的主流手术方法。

背景:局部应用氨甲环酸可减少退变性疾病行全髋关节置换后的引流,但其应用于单纯老年股骨颈骨折行初次全髋关节置换的研究报道相对较少。
目的:分析局部应用氨甲环酸减少老年股骨颈骨折患者全髋关节置换后引流的安全和有效性。
方法:纳入2019年1至12月郑州人民医院收治的45例老年股骨颈骨折患者,男19例,女26例,年龄59-82岁,均接受全髋关节置换治疗,其中21例全髋关节置换手术完成缝皮后经引流管逆行注入氨甲环酸(观察组),24例全髋关节置换手术完成缝皮后经引流管逆行注入生理盐水(对照组)。记录术后引流量与不良事件发生情况,密切观察切口愈合情况,检查凝血功能。试验获得郑州人民医院医学伦理委员会批准。
结果与结论:①所有患者术后切口均甲级愈合,术后未出现心肌梗死、脑梗死、肺栓塞、下肢深静脉血栓;②观察组术后3 d内的总引流量、血红蛋白丢失量少于对照组(P < 0.05);③两组术后活化部分凝血酶原时间、凝血酶原时间、凝血酶时间、纤维蛋白原比较差异无显著性意义(P > 0.05);④结果表明,局部应用氨甲环酸在老年股骨颈骨折患者全髋关节置换中安全有效,在不影响凝血功能的情况下可显著减少术后引流量。
https://orcid.org/0000-0001-9535-7317 (张冲) 

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: 骨, 假体, 关节置换, 股骨颈, 骨折, 全髋关节置换, 氨甲环酸, 凝血功能, 术后引流

Abstract: BACKGROUND: Topical application of tranexamic acid can reduce the drainage after total hip arthroplasty for degenerative diseases. However, there are few reports on the application of tranexamic acid in primary total hip arthroplasty for simple elderly femoral neck fracture.   
OBJECTIVE: To analyze the safety and effectiveness of topical application of tranexamic acid to reduce drainage of elderly femoral neck fractures after total hip arthroplasty. 
METHODS: Forty-five elderly femoral neck fractures patients undergoing total hip arthroplasty in the Zhengzhou People’s Hospital from January to December 2019 were enrolled in this study, including 19 males and 26 females at the age of 59-82 years old. Twenty-one patients in the observation group were injected with tranexamic acid retrogradely through the drainage tube after total hip arthroplasty. Twenty-four patients in the control group were injected with normal saline retrogradely through the drainage tube after total hip arthroplasty. The postoperative drainage volume and adverse events were recorded; the wound healing was closely observed; and the coagulation function was checked. This study was approved by the Medical Ethics Committee of Zhengzhou People’s Hospital. 
RESULTS AND CONCLUSION: (1) All patients’ incisions healed grade A, and no myocardial infarction, cerebral infarction, pulmonary embolism, or deep vein thrombosis of the lower extremities occurred. (2) At postoperative 3 days, total drainage and hemoglobin loss were less in the observation group than those in the control group (P < 0.05). (3) Activated partial prothrombin time, prothrombin time, thrombin time, and fibrinogen were not significantly different between the two groups after surgery (P > 0.05). (4) Results suggested that topical application of tranexamic acid in total hip arthroplasty for elderly femoral neck fractures is safe and effective. It can significantly reduce postoperative drainage without affecting coagulation function.

Key words: bone, prosthesis, arthroplasty, femoral neck, fracture, total hip arthroplasty, tranexamic acid, coagulation function, postoperative drainage

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