Schiavone Andrea, Bisaccia Michele, Inkov Ivan, Rinonapoli Giuseppe, Manni Mattia, Rollo Giuseppe, Meccariello Luigi, Vicente Cristina Ibáñez, Ceccarini Paolo, Ruggiero Carmelinda, Caraffa Auro
Division of Orthopedics and Trauma Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy.
Department of Thoracic Surgery, Military Medical Academy, Sofia, Bulgaria.
Folia Med (Plovdiv). 2018 Mar 1;60(1):67-78. doi: 10.1515/folmed-2017-0070.
There is a high incidence of blood transfusion following hip fractures in elderly patients.
The aim of this study is to evaluate the effectiveness and complications of use of tranexamic acid in proximal femur nailing surgery.
Our sample group consisted of 90 patients suffering from pertrochanteric fractures surgically treated with osteosynthesis with SupernailGT(LimaCorporate). The classification system AO/OTA was used to divide the fractures into 31A1 (n=45) and 31A2 (n=45). The patients were divided into two groups: 47 patients were administered 15 mg of tranexamic acid per kg (group A) and 43 patients were administered placebo (group B). Blood counts were monitored daily to evaluate the rate of anemia. As a safety criterion, we monitored the possible occurrence of vascular events, symptomatic or not, over the 8 weeks post-surgery. Markers predicting mortality and deep venous thrombosis (DVE) were also monitored (fibrinogen D-dimer).
Blood loss occurring post-surgery can be influenced by numerous factors that are not linked to the use or non-use of tranexamic acid. While closely monitoring hemoglobin levels daily, we observed that 42% of the patients in group A required blood transfusion as opposed to 60% in group B. The results of the markers predicting mortality (alpha1-acid glycoprotein; albumin LDL) and those of DVE were not statistically significant between the two groups in this study (p>0.05).
Based on this study, the use of tranexamic acid was statistically significant in reducing post-surgery blood loss.
老年患者髋部骨折后输血发生率较高。
本研究旨在评估氨甲环酸在股骨近端髓内钉手术中的有效性及并发症。
我们的样本组由90例采用Supernail GT（利马公司）进行手术内固定治疗的转子间骨折患者组成。采用AO/OTA分类系统将骨折分为31A1型（n = 45）和31A2型（n = 45）。患者分为两组：47例患者每千克体重给予15 mg氨甲环酸（A组），43例患者给予安慰剂（B组）。每天监测血细胞计数以评估贫血发生率。作为安全标准，我们监测术后8周内有无症状性血管事件的发生情况。还监测了预测死亡率和深静脉血栓形成（DVT）的指标（纤维蛋白原D - 二聚体）。
术后失血可受多种与是否使用氨甲环酸无关的因素影响。在每日密切监测血红蛋白水平时，我们观察到A组42%的患者需要输血，而B组为60%。本研究中，两组间预测死亡率的指标（α1 - 酸性糖蛋白；白蛋白低密度脂蛋白）及DVT指标的结果无统计学意义（p>0.05）。
基于本研究，氨甲环酸在减少术后失血方面具有统计学意义。
