Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea.
Medicine (Baltimore). 2022 Jul 22;101(29):e29574. doi: 10.1097/MD.0000000000029574.
Pelvic bone fractures may cause extensive bleeding; however, the efficacy of tranexamic acid (TXA) usage in pelvic fracture surgery remains unclear. In this systematic review and meta-analysis, we aimed to evaluate the efficacy of TXA in open reduction and internal fixation surgery for pelvic and acetabular fracture.
MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before April 22, 2020, that investigated the effect of TXA in the treatment of pelvic and acetabular fracture with open reduction and internal fixation. A pooled analysis was used to identify the differences between a TXA usage group and a control group in terms of estimated blood loss (EBL), transfusion rates, and postoperative complications.
We included 6 studies involving 764 patients, comprising 293 patients who received TXA (TXA group) and 471 patients who did not (control group). The pooled analysis showed no differences in EBL between the groups (mean difference -64.67, 95% confidence interval [CI] -185.27 to -55.93, P = .29). The study period transfusion rate showed no significant difference between the groups (odds ratio [OR] 0.77, 95% CI 0.19-3.14, P = .71, I2 = 82%), nor in venous thromboembolism incidence (OR 1.53, 95% CI 0.44-5.25, P = .50, I2 = 0%) or postoperative infection rates (OR 1.15, 95% CI 0.13-9.98, P = .90, I2 = 48%).
Despite several studies having recommended TXA administration in orthopedic surgery, our study did not find TXA usage to be more effective than not using TXA in pelvic and acetabular fracture surgery, especially in terms of EBL reduction, transfusion rates, and the risk of postoperative complications.
骨盆骨折可导致广泛出血；然而，氨甲环酸（TXA）在骨盆骨折手术中的疗效尚不清楚。在这项系统评价和荟萃分析中，我们旨在评估 TXA 在骨盆和髋臼骨折切开复位内固定术中的疗效。
系统检索了 MEDLINE、Embase 和 Cochrane 图书馆数据库，以获取截至 2020 年 4 月 22 日发表的关于 TXA 治疗切开复位内固定骨盆和髋臼骨折疗效的研究。采用汇总分析比较 TXA 使用组和对照组在估计失血量（EBL）、输血率和术后并发症方面的差异。
我们纳入了 6 项研究，共纳入 764 例患者，其中 293 例患者接受了 TXA（TXA 组），471 例患者未接受 TXA（对照组）。汇总分析显示，两组间 EBL 无差异（平均差-64.67，95%置信区间[CI]-185.27 至-55.93，P=.29）。研究期间输血率两组间无显著差异（比值比[OR]0.77，95%CI0.19-3.14，P=.71，I2=82%），静脉血栓栓塞发生率（OR1.53，95%CI0.44-5.25，P=.50，I2=0%）或术后感染率（OR1.15，95%CI0.13-9.98，P=.90，I2=48%）也无差异。
尽管有几项研究建议在骨科手术中使用 TXA，但我们的研究并未发现 TXA 比不使用 TXA 更能有效治疗骨盆和髋臼骨折，尤其是在减少 EBL、输血率和术后并发症风险方面。
