Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, People's Republic of China.
The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, People's Republic of China.
Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211002277. doi: 10.1177/10760296211002277.
Femoral shaft nonunion is a complication that seriously affects physiological functions. We aimed to assess the effectiveness and safety of short- and long-term intravenous tranexamic acid (TXA) administration in the perioperative period of revision surgery for femoral shaft nonunion. In this retrospective study, 53 patients undergoing double-locking plates with channel bone grafting technology for the treatment of femoral shaft nonunion were divided into 3 groups: the patients in group A without use TXA during hospitalization, the patients in group B received intravenous (IV) 1-g TXA at 30 min before the surgery and deep soaked 1-g TXA for 5 min before closing the incision, and then 1-g TXA IV again 6 h after surgery, and the patients in group C received 1-g TXA IV before the operation, 1-g TXA topically during the operation, and subsequent long-term 1-g TXA IV until discharged. The primary outcomes were total blood loss (TBL) and hidden blood loss (HBL). The secondary outcomes included actual hemoglobin (Hb) loss values, transfusion requirement, number of units transfused, postoperative laboratory values (Hb, hematocrit, fibrinogen, and D-dimer), visual analogue scale (VAS) scores, and hospitalization time. The mean TBL was lower in group C than in group A (1168 mL vs. 2714 mL, < 0.001) and group B (1168 mL vs. 1557 mL, = 0.008). The differences in HBL volumes were also significant between groups A and C ( < 0.001) and between groups A and B ( < 0.01). The actual Hb loss in the 3 groups showed a consistent trend with TBL, but no significant differences between groups B and C ( = 0.23). On postoperative day (POD) 3, the Hb level was higher in group C than in group A (111.1 g/L vs. 94.6 g/L, = 0.02). No significant differences were found in VAS, hospital stay, thromboembolic complications, incision-related complications, and TXA adverse reactions among groups. Long-term intravenous TXA during hospitalization can effectively reduce perioperative blood loss, Hb drop, and postoperative hyperfibrinolysis, but is associated with an increased incidence of adverse reactions.
股骨干骨不连是一种严重影响生理功能的并发症。我们旨在评估短期和长期静脉注射氨甲环酸（TXA）在股骨干骨不连翻修手术围手术期的有效性和安全性。在这项回顾性研究中，53 名接受双锁定钢板联合通道骨移植技术治疗股骨干骨不连的患者分为 3 组：A 组患者在住院期间不使用 TXA，B 组患者在手术前 30 分钟静脉注射（IV）1g TXA，并在关闭切口前深浸 1g TXA 5 分钟，然后在手术后 6 小时再次静脉注射 1g TXA，C 组患者在手术前静脉注射 1g TXA，手术中局部使用 1g TXA，随后长期静脉注射 1g TXA 直至出院。主要结局是总失血量（TBL）和隐性失血量（HBL）。次要结局包括实际血红蛋白（Hb）丢失值、输血需求、输血量、术后实验室值（Hb、红细胞压积、纤维蛋白原和 D-二聚体）、视觉模拟评分（VAS）评分和住院时间。C 组的平均 TBL 低于 A 组（1168mL 比 2714mL， < 0.001）和 B 组（1168mL 比 1557mL， = 0.008）。A 组和 C 组之间的 HBL 体积差异也有统计学意义（ < 0.001），A 组和 B 组之间也有统计学意义（ < 0.01）。3 组实际 Hb 丢失与 TBL 呈一致趋势，但 B 组和 C 组之间无显著差异（ = 0.23）。在术后第 3 天（POD），C 组的 Hb 水平高于 A 组（111.1g/L 比 94.6g/L， = 0.02）。3 组间 VAS、住院时间、血栓栓塞并发症、切口相关并发症和 TXA 不良反应无显著差异。住院期间长期静脉注射 TXA 可有效减少围手术期失血、Hb 下降和术后纤维蛋白溶解亢进，但与不良反应发生率增加有关。
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