Department of orthopedics, Dong Nan Hospital, Chongqing, China.
Department of orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Medicine (Baltimore). 2022 Sep 9;101(36):e30567. doi: 10.1097/MD.0000000000030567.
There is still a conflict between early surgical decompression and increased bleeding resulting from early surgery for thoracolumbar burst fractures (TBF) with neurological symptoms. The aim of this study is to investigate the effect of early continuously intravenous tranexamic acid (TXA) on perioperative blood loss in TBF with neurological symptoms who underwent early surgery. A retrospective comparative analysis was performed. The patients in study group were treated with intravenous TXA 15 mg/kg every 24 hours after admission besides intravenous TXA 15 mg/kg before skin incision and patients in control group were treated with intravenous TXA 15 mg/kg before skin incision only. Perioperative blood loss was compared between the 2 groups. The hemoglobin at admission, before surgery, 1 day and 3 days after surgery, the operation time, drainage time, blood transfusion and volume, incidence of complications and length of hospital stay were also compared. The operation time, preoperative, intraoperative, total, hidden amounts of blood loss in TXA group were significantly lower than those in control group (P < .001). The hemoglobin level in the TXA group was significantly higher than that in the control group before and 1 day after surgery (P < .05). The remove drainage time, hospitalization time, blood transfusion rate and volume in the TXA group were significantly lower than those in the control group (P < .001). There was no significant difference in the incidence of lower limb thrombosis between the 2 groups (P > .05). Early continuously intravenous TXA reduces the perioperative blood loss of patients with TBF who underwent early posterior fracture reduction, nerve decompression and pedicle screw fixation.
对于合并神经症状的胸腰椎爆裂骨折（TBF）患者，早期手术减压与早期手术导致的出血量增加之间仍然存在矛盾。本研究旨在探讨早期持续静脉应用氨甲环酸（TXA）对合并神经症状的 TBF 患者早期手术围手术期出血量的影响。进行了回顾性对比分析。研究组患者在入院后每 24 小时静脉注射 TXA 15mg/kg，在切开皮肤前静脉注射 TXA 15mg/kg，对照组患者仅在切开皮肤前静脉注射 TXA 15mg/kg。比较两组患者的围手术期出血量。比较两组患者入院时、术前、术后 1 天和 3 天的血红蛋白、手术时间、引流时间、输血及输血量、并发症发生率和住院时间。TXA 组的手术时间、术前、术中、总失血量和隐匿性失血量明显低于对照组（P<0.001）。TXA 组患者术前和术后 1 天的血红蛋白水平明显高于对照组（P<0.05）。TXA 组患者的引流拔除时间、住院时间、输血率和输血量明显低于对照组（P<0.001）。两组患者下肢血栓形成的发生率无明显差异（P>0.05）。早期持续静脉应用 TXA 可减少早期后路骨折复位、神经减压和椎弓根螺钉固定治疗 TBF 患者的围手术期出血量。
