Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
Eur J Trauma Emerg Surg. 2023 Feb;49(1):209-216. doi: 10.1007/s00068-022-02042-6. Epub 2022 Jul 19.
The aim of our study was to investigate the use of tranexamic acid in patients with proximal femoral fractures and compare the total blood loss, transfusion rates, complications, and the application method.
A retrospective single center cohort study (level I trauma center) with 1479 patients treated operatively for a proximal femoral fracture between January 2016 and June 2020 was performed. 1 g of tranexamic acid was applied (systemic, topic or combined application). Patient data, surgical procedure, complications, and mortality were assessed. Hemoglobin levels, blood loss and transfusion rates for patients with and without tranexamic acid and the application methods were compared.
667 femoral neck fractures, 701 pertrochanteric and 109 subtrochanteric fractures were included. Mean age was 80.8 years. 274 patients received tranexamic acid. At admission average hemoglobin was 12.2 g/l. Hemoglobin drop postoperatively was less after tranexamic acid (9.72 vs. 9.35 g/dl). Transfusion rates were lowered significantly by 17.1% after tranexamic acid. Blood loss was reduced for all patients after tranexamic acid independent of fracture morphology. The combination of 1 g i.v. and 1 g topical-applied tranexamic acid seems to be more effective. Complication rates did not differ.
Tranexamic acid is effective in reducing blood loss and transfusion rates, without increasing the risk of thromboembolic events after proximal femoral fractures. For open reduction and nailing and arthroplasty in fracture setting combined topical and single i.v. application seems most effective and closed reduction with nailing can be treated by single dose i.v. application of 1 g tranexamic acid.
本研究旨在探讨氨甲环酸在股骨近端骨折患者中的应用，并比较总失血量、输血率、并发症以及应用方法。
回顾性单中心队列研究（I 级创伤中心），纳入 2016 年 1 月至 2020 年 6 月期间接受手术治疗的 1479 例股骨近端骨折患者。应用 1g 氨甲环酸（全身、局部或联合应用）。评估患者数据、手术过程、并发症和死亡率。比较有和无氨甲环酸患者以及不同应用方法的血红蛋白水平、失血量和输血率。
纳入 667 例股骨颈骨折、701 例股骨粗隆间骨折和 109 例股骨转子下骨折。患者平均年龄为 80.8 岁。274 例患者接受了氨甲环酸治疗。入院时平均血红蛋白为 12.2g/L。氨甲环酸治疗后术后血红蛋白下降更少（9.72 比 9.35g/dl）。输血率显著降低了 17.1%。所有患者在使用氨甲环酸后失血量均减少，与骨折形态无关。静脉注射 1g 和局部应用 1g 氨甲环酸联合应用似乎更有效。并发症发生率无差异。
氨甲环酸可有效减少股骨近端骨折患者的失血量和输血率，且不会增加血栓栓塞事件的风险。对于切开复位内固定和关节置换术，联合局部和单次静脉应用氨甲环酸似乎最有效，而闭合复位内固定术可单次静脉应用 1g 氨甲环酸治疗。
