Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 14068, South Korea.
Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
BMC Musculoskelet Disord. 2019 May 17;20(1):228. doi: 10.1186/s12891-019-2615-z.
Perioperative blood management is an important issue in the treatment of elderly patients at an increased risk of postoperative complications. Accordingly, tranexamic acid (TXA) is widely administered to reduce blood loss and transfusion requirements. In this case-control study, the effect of topical TXA on the outcomes of elderly patients with femoral neck fractures after hemiarthroplasty was evaluated.
This study enrolled elderly patients (age ≥ 70 years) who underwent cementless bipolar hemiarthroplasty for femoral neck fractures between January 2015 and January 2017. The study group comprised 72 patients who received TXA via topical administration during surgery. After propensity matching, the control group comprised 72 patients who did not receive topical TXA. The perioperative and postoperative parameters of the two groups were compared.
The estimated blood loss, vacuum tube drainage, and total transfusion volume were significantly lower in the study group than the control (p = 0.024, 0.003, and 0.019, respectively). Despite a lack of significant intergroup differences in the lengths of ICU and hospital stays; rates of ICU admission, venous thromboembolism, delirium, and readmission; and rates of in-hospital and 1-year mortality, the incidence of postoperative medical complications was significantly lower in the study group (p = 0.003).
Topical TXA administration appears to be a simple and effective option for reducing blood loss, transfusion requirements, and medical complications after hemiarthroplasty in elderly patients with femoral neck fractures.
围手术期血液管理是治疗术后并发症风险增加的老年患者的一个重要问题。因此，氨甲环酸（TXA）被广泛用于减少失血和输血需求。在本病例对照研究中，评估了局部使用 TXA 对接受人工股骨头置换术的老年股骨颈骨折患者结局的影响。
本研究纳入了 2015 年 1 月至 2017 年 1 月期间接受无水泥双极股骨头置换术治疗的老年（年龄≥70 岁）股骨颈骨折患者。研究组 72 例患者术中给予 TXA 局部应用，通过倾向评分匹配后，对照组 72 例患者未给予 TXA 局部应用。比较两组围手术期和术后参数。
研究组的估计失血量、真空引流管引流量和总输血量均显著低于对照组（p=0.024、0.003 和 0.019）。尽管两组 ICU 住院时间和住院时间、ICU 入住率、静脉血栓栓塞、谵妄和再入院率以及院内和 1 年死亡率无显著差异，但研究组术后医疗并发症发生率显著降低（p=0.003）。
局部使用 TXA 似乎是一种简单有效的方法，可以减少老年股骨颈骨折患者行人工股骨头置换术后的失血、输血需求和医疗并发症。
