Xu Xinxian, Xie Linghui, Yu Huachen, Hu Yuezheng
Department of Osteopathy, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Radiology, Wenzhou Seventh Hospital, Wenzhou, China.
Acta Orthop Traumatol Turc. 2020 Mar;54(2):132-137. doi: 10.5152/j.aott.2020.02.135.
This study aimed to determine whether the local administration of tranexamic acid (TXA) combined with diluted epinephrine (DEP) reduces blood loss and the need for transfusions compared with the administration of TXA alone following surgery for trochanteric femoral fractures.
Hundred patients were enrolled in this study. In the target group (TXA/DEP group: n=50; 19 men and 31 women, mean age 72.5±11.1 years), the surgical sites were injected with 35 mL normal saline mixed with 3 g of TXA with 0.2 mg of DEP at a 1:200,000 dilution (TXA/DEP) immediately after musculoaponeurotic closure. In the control group (TXA group: n=50; 22 men and 28 women; mean age: 70.5±12.2 years), the surgical site was injected with 35 mL normal saline containing 3 g of TXA alone. The main outcome measures were postoperative hemoglobin (Hb) levels, hematocrit, drainage volume, and total blood loss (TBL); the secondary measures included transfusion requirements and perioperative complications.
The mean Hb levels among patients in theTXA/DEP group were significantly lower than among those in the TXA group, measured on postoperative day 1 at 101.0±14.1 g/L vs. 106.9±10.5 g/L and day 3 as 104.2±8.2 g/L vs. 108.5±9.1 g/L, respectively (p<0.05). Drainage volume from the surgical site and TBL measured on postoperative day 2 were also significantly reduced in the TXA/DEP group vs. the TXA group, measured at 71.4±26.0 mL vs. 82.5±24.6 mL and 343.6±148.0 mL vs. 419.6±165.4 mL, respectively (p<0.05). Furthermore, 11 patients (22%) from the TXA group and 15 (30%) from the TXA/DEP group received blood transfusions; the mean number of transfusion events (1.2±0.4 vs. 1.9±0.7) and the amount of blood transfused (1.7±0.5 Units vs. 2.9±1.0 Units) was also markedly reduced in the TXA/DEP group (p<0.05). Two cases in the TXA/DEP group and three in the TXA group were diagnosed with deep vein thrombosis, a difference that did not reach statistical significance (p>0.05).
Local administration of TXA with DEP reduced blood loss and limited the need for blood transfusions after surgery for trochanteric femoral fracture without increasing the risk of perioperative complications. Our study indicates that the local administration of TXA/DEP is safe and more effective than the administration of TXA alone in treating trochanteric femoral fractures.
Level III, Therapeutic study.
本研究旨在确定与单纯使用氨甲环酸（TXA）相比，局部应用氨甲环酸联合稀释肾上腺素（DEP）在股骨转子间骨折手术后是否能减少失血及输血需求。
本研究纳入了100例患者。在目标组（TXA/DEP组：n = 50；19例男性和31例女性，平均年龄72.5±11.1岁）中，在肌肉腱膜闭合后立即向手术部位注射35 mL生理盐水，其中混合3 g TXA与0.2 mg以1:200,000稀释的DEP（TXA/DEP）。在对照组（TXA组：n = 50；22例男性和28例女性；平均年龄：70.5±12.2岁）中，向手术部位仅注射35 mL含3 g TXA的生理盐水。主要观察指标为术后血红蛋白（Hb）水平、血细胞比容、引流量和总失血量（TBL）；次要指标包括输血需求和围手术期并发症。
TXA/DEP组患者术后第1天的平均Hb水平显著低于TXA组，分别为101.0±14.1 g/L vs. 106.9±10.5 g/L，术后第3天为104.2±8.2 g/L vs. 108.5±9.1 g/L（p<0.05）。与TXA组相比，TXA/DEP组术后第2天手术部位的引流量和TBL也显著减少，分别为71.4±26.0 mL vs. 82.5±24.6 mL和343.6±148.0 mL vs. 419.6±165.4 mL（p<0.05）。此外，TXA组有11例患者（22%）接受了输血，TXA/DEP组有15例患者（30%）接受了输血；TXA/DEP组的平均输血次数（1.2±0.4 vs. 1.9±0.7）和输血量（1.7±0.5单位vs. 2.9±1.0单位）也明显减少（p<0.05）。TXA/DEP组有2例患者和TXA组有3例患者被诊断为深静脉血栓形成，差异无统计学意义（p>0.05）。
局部应用TXA联合DEP可减少股骨转子间骨折手术后的失血，并减少输血需求，且不增加围手术期并发症的风险。我们的研究表明，局部应用TXA/DEP在治疗股骨转子间骨折方面比单纯应用TXA更安全、更有效。
III级，治疗性研究。
