Sahin Ertugrul, Berk Haluk, Ozkal Sermin, Keskinoglu Pembe, Balci Pinar, Balci Ali
Department of Orthopaedics and Traumatology, Kemalpasa State Hospital, Izmir, Turkey.
Department of Orthopaedics and Traumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
Spine Surg Relat Res. 2021 Oct 11;6(2):151-158. doi: 10.22603/ssrr.2021-0113. eCollection 2022.
The use of the antifibrinolytic agent tranexamic acid has positive effects on bleeding control, but our knowledge is still limited regarding how fibrinolysis suppression changes the process of bone formation and the quality of bone. Because of the several side effects of systemic tranexamic acid, topical usage has been established in several procedures. This study aimed to investigate the effect of local tranexamic acid on vertebral fusion by using macroscopic, radiologic, and microscopic techniques. We also attempted to determine the safe dose range in case some doses had negative effects on fusion.
Twenty-eight Wistar albino rats underwent intertransverse fusion. All rats were randomized into four groups: groups treated with local tranexamic acid doses of 1 mg/kg (D1), 10 mg/kg (D10), and 100 mg/kg (D100) and the control group with no drug (D0). At the end of the eighth week, all rats were sacrificed for evaluation in terms of palpation, mammography, and histopathologic analysis.
The manual palpation results presented with lower fusion rates in D10 and D100 groups than in the control group. Radiological examination results were significantly higher in the control group. The histopathologic examination revealed no significant differences between groups in the percent of new bone formation.
Our results showed that local administration of tranexamic acid reduced the quality and stability of fusion without a delay in bone formation. However, doses of 1 mg/kg did not reduce the stability in the palpation test. Our findings suggest that 1 mg/kg dose is a critical threshold above which tranexamic acid reduced the bone healing process of fusion and that surgeons should consider the doses of local tranexamic acid during surgery.
抗纤维蛋白溶解剂氨甲环酸的使用对出血控制有积极作用，但我们对于纤维蛋白溶解抑制如何改变骨形成过程和骨质量的了解仍然有限。由于全身性氨甲环酸有多种副作用，其局部应用已在多个手术中得到确立。本研究旨在通过宏观、放射学和微观技术研究局部氨甲环酸对椎体融合的影响。我们还试图确定在某些剂量对融合有负面影响的情况下的安全剂量范围。
28只Wistar白化大鼠接受横突间融合术。所有大鼠随机分为四组：分别用1mg/kg（D1）、10mg/kg（D10）和100mg/kg（D100）的局部氨甲环酸剂量治疗的组以及无药物的对照组（D0）。在第八周结束时，所有大鼠均被处死，以便进行触诊、乳房X线摄影和组织病理学分析评估。
触诊结果显示，D10组和D100组的融合率低于对照组。放射学检查结果在对照组中显著更高。组织病理学检查显示，各组在新骨形成百分比方面无显著差异。
我们的结果表明，局部应用氨甲环酸会降低融合的质量和稳定性，而不会延迟骨形成。然而，1mg/kg的剂量在触诊试验中并未降低稳定性。我们的研究结果表明，1mg/kg的剂量是一个关键阈值，高于此阈值氨甲环酸会降低融合的骨愈合过程，并且外科医生在手术期间应考虑局部氨甲环酸的剂量。
