UOC Ortopedia e Traumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
UOC Ortopedia e Traumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
Injury. 2020 Aug;51 Suppl 3:S23-S27. doi: 10.1016/j.injury.2020.05.026. Epub 2020 May 23.
Every year more than 300,000 proximal femur fractures are diagnosed. Their number will double within 30 years. In femoral neck fractures treated with hip hemiarthroplasty 90-days mortality is 29.5-51.6%. Haemorrhage is one amongst other complications that is associated with increasing postoperative mortality. Transfusion rate in these patients ranges from 25.7% to 39%. Blood transfusions expose to complications. Fibrin sealants are useful in reducing perioperative need for transfusions, total blood loss, blood loss from drainage. The aim of this study is to assess whether the use of a fibrin sealant during hip hemiarthroplasty implant reduces the need for transfusion.
All patients admitted with a proximal femur fracture from September 2018 to May 2019 were reviewed. Inclusion criteria were: femoral neck fracture AO 31B2-3, hip hemiarthroplasty. Exclusion criteria were: previous surgery on the affected hip, coagulation disorders, hematopoietic disorders. Patients were divided in fibrin sealant group and control group. All patients underwent partial hip replacement through a posterolateral approach. 4 ml of fibrin sealant (EVICEL, Omrix Biopharmaceuticals, Diegem, Belgium) were sprayed on the soft tissues of patients included in the fibrin sealant group. Primary outcome of our study was need for perioperative transfusion. Secondary outcomes were: mean red blood cell transfused volume, variations in haematocrit and haemoglobin and total blood volume loss.
Eighty-one consecutive patients were enrolled. EVICEL was used on 19 patients, standard haemostatic care on 62 patients. Two patients were transfused in the fibrin sealant group, 22 in the control group (p 0,0371). Mean transfused volume was 21,05 ml in the fibrin sealant group and 116,16 ml in the control group (p 0,0017). No significant difference could be found in haematocrit and haemoglobin variation and total blood loss.
A reduction in transfusional need with the use of fibrin sealants was reported in studies on total hip arthroplasty and was confirmed by our study.
EVICEL reduces need for transfusion in patients undergoing hip hemiarthroplasty for a femoral neck fracture. It must be held among the options when a stricter control on transfusional requirement is needed.
每年有超过 30 万例股骨近端骨折被诊断出来。在 30 年内，这个数字将翻一番。在接受髋关节半髋关节置换术治疗的股骨颈骨折患者中，90 天死亡率为 29.5-51.6%。出血是与术后死亡率增加相关的并发症之一。这些患者的输血率在 25.7%至 39%之间。输血会带来并发症。纤维蛋白胶在减少围手术期输血、总失血量、引流失血量方面非常有用。本研究旨在评估髋关节半髋关节置换术中使用纤维蛋白胶是否能减少输血需求。
回顾 2018 年 9 月至 2019 年 5 月期间因股骨近端骨折入院的所有患者。纳入标准为：股骨颈骨折 AO 31B2-3、髋关节半髋关节置换术。排除标准为：受影响髋关节的既往手术、凝血障碍、血液系统疾病。患者分为纤维蛋白胶组和对照组。所有患者均通过后外侧入路行部分髋关节置换术。纤维蛋白胶组（EVICEL，奥米克斯生物制药，比利时迪盖姆）喷洒 4ml 纤维蛋白胶于患者的软组织上。本研究的主要结果是围手术期输血需求。次要结果为：平均红细胞输注量、血细胞比容和血红蛋白变化及总血容量损失。
连续纳入 81 例患者。19 例患者使用 EVICEL，62 例患者使用标准止血护理。纤维蛋白胶组有 2 例患者输血，对照组有 22 例（p<0.0371）。纤维蛋白胶组平均输血量为 21.05ml，对照组为 116.16ml（p<0.0017）。血细胞比容和血红蛋白变化及总血容量损失无显著差异。
在全髋关节置换术的研究中，纤维蛋白胶的使用减少了输血的需求，本研究也证实了这一点。
EVICEL 可减少股骨颈骨折行髋关节半髋关节置换术患者的输血需求。当需要更严格地控制输血时，它必须是选择之一。
