Department of Orthopedics, Dalian Medical University, Dalian, 116000, China; Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China.
Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China.
Clin Neurol Neurosurg. 2020 Jun;193:105766. doi: 10.1016/j.clineuro.2020.105766. Epub 2020 Mar 2.
To evaluate the efficacy and safety of tranexamic acid (TXA) for single-segment thoracolumbar burst fracture without neurologic injury underwent pedicle screw fixation via Wiltse approach.
We identified 264 patients with single-segment thoracolumbar burst fracture without neurologic injury underwent pedicle screw fixation via Wiltse approach (January 2016-June 2019) at a single center. The cohort was separated into three groups. Group A received 20 mg/kg TXA at 5 min before skin incision and 16 h after first dose; Group B received 20 mg/kg TXA at 5 min before skin incision; Group C received NS at each same time point. The outcomes were evaluated by hidden blood loss (HBL), total blood loss (TBL), intraoperative blood loss (IBL), transfusion rate, maximum hemoglobin (Hb) drop, prethrombotic state molecular markers, liver and renal function, coagulation function, inflammatory factor and adverse events.
The HBL, TBL and maximum Hb drop were significantly lower in Group A than those of Group B and Group C, while the difference between Group B and Group C was statistically significant. The IBL was significantly lower in Group A and Group B than that of Group C. However, there was no significantly difference among the three groups in live and renal function, coagulation function, prethrombotic state molecular markers, transfusion rate and complications during the perioperative period. There was significantly lower level of interleukin-6 (IL-6) in Group A than Group C at the day after surgery, and lower level of C-reactive protein (CRP) at the third day after surgery.
Intravenous TXA used in the treatment of thoracolumbar burst fracture underwent pedicle screw fixation via Wiltse approach is effective and safe in decreasing perioperative blood loss. The two-dose TXA regimen can further reduce blood loss and alleviate post-operative inflammation response, without affecting prethrombotic state molecular marks and without increasing the risk of complications.
评估氨甲环酸（TXA）在经 Wiltse 入路行椎弓根螺钉固定治疗无神经损伤单节段胸腰椎爆裂骨折中的疗效和安全性。
我们在一家中心确定了 264 例经 Wiltse 入路行椎弓根螺钉固定治疗的无神经损伤单节段胸腰椎爆裂骨折患者。该队列分为三组。A 组在皮肤切开前 5 分钟和首次剂量后 16 小时给予 20mg/kgTXA；B 组在皮肤切开前 5 分钟给予 20mg/kgTXA；C 组在每个相同时间点给予 NS。通过隐性失血（HBL）、总失血量（TBL）、术中失血量（IBL）、输血率、最大血红蛋白（Hb）下降、血栓前状态分子标志物、肝肾功能、凝血功能、炎症因子和不良事件来评估结果。
A 组的 HBL、TBL 和最大 Hb 下降明显低于 B 组和 C 组，而 B 组与 C 组之间的差异具有统计学意义。A 组和 B 组的 IBL 明显低于 C 组。然而，三组在围手术期肝肾功能、凝血功能、血栓前状态分子标志物、输血率和并发症方面无明显差异。与 C 组相比，A 组术后第 1 天白细胞介素-6（IL-6）水平明显降低，术后第 3 天 C 反应蛋白（CRP）水平明显降低。
在经 Wiltse 入路行椎弓根螺钉固定治疗胸腰椎爆裂骨折中，静脉应用 TXA 可有效减少围手术期失血。两剂量 TXA 方案可进一步减少出血量，减轻术后炎症反应，而不影响血栓前状态分子标志物，也不增加并发症的风险。
