Drakos Athanasios, Raoulis Vasilios, Karatzios Konstantinos, Doxariotis Nikolaos, Kontogeorgakos Vasilios, Malizos Konstantinos, Varitimidis Sokratis E
*Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece; and †Department of Orthopaedics, Attikon University Hospital, Athens, Greece.
J Orthop Trauma. 2016 Aug;30(8):409-14. doi: 10.1097/BOT.0000000000000577.
The primary aim of this study was to assess whether local administration of tranexamic acid (TXA) reduced the need for a blood transfusion in elderly patients treated with an intramedullary (IM) nail for an intertrochanteric fracture.
Randomized prospective trial.
Academic level 1 trauma center.
Two hundred patients (200 fractures) over 65 years with an intertrochanteric fracture treated by IM nail between April 1, 2012, and March 31, 2014.
Subfascial administration of 3 g of TXA around the fracture site at the end of the surgical procedure, versus a control group without TXA. Follow-up ranged from 12 to 24 months.
Group differences in number of transfused packed red blood cell (PRBC) units, and hematocrit, hemoglobin, and platelet count.
There was a 43% reduction in transfusion requirements in the TXA group (P < 0.01). Twenty-seven units of PRBC were transfused in 22/100 patients in the TXA group, whereas 48 PRBC units were transfused in 29/100 patients in control group. There was no difference between the 2 groups in terms of late complications and overall mortality rate.
Subfascial administration of TXA around the fracture site in elderly patients undergoing IM nailing for intertrochanteric fractures is safe and cost-effective. A significant reduction in blood loss and transfused blood units, and health care cost can be achieved.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
本研究的主要目的是评估局部应用氨甲环酸（TXA）是否能减少老年转子间骨折患者行髓内钉（IM）固定术后的输血需求。
随机前瞻性试验。
一级学术创伤中心。
2012年4月1日至2014年3月31日期间，200例65岁以上转子间骨折患者（200处骨折）接受IM钉治疗。
手术结束时在骨折部位筋膜下注射3g TXA，与未使用TXA的对照组相比。随访时间为12至24个月。
输注浓缩红细胞（PRBC）单位数量、血细胞比容、血红蛋白和血小板计数的组间差异。
TXA组输血需求减少43%（P<0.01）。TXA组100例患者中的22例输注了27个单位的PRBC，而对照组100例患者中的29例输注了48个PRBC单位。两组在晚期并发症和总死亡率方面无差异。
老年转子间骨折患者行IM钉固定时，在骨折部位筋膜下应用TXA是安全且具有成本效益的。可显著减少失血量和输血量，降低医疗费用。
治疗性I级。有关证据级别的完整描述，请参阅作者指南。
