Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Strasse 165, 06120, Halle (Saale), Germany.
Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
BMC Musculoskelet Disord. 2022 Nov 3;23(1):950. doi: 10.1186/s12891-022-05889-3.
Treatment of pertrochanteric femoral fractures is often associated with significant blood loss. It has already been demonstrated that the administration of tranexamic acid (TXA) for endoprosthetic procedures reduces blood losses and leads to a decreased frequency of postoperative complications. The aim of this study is to demonstrate whether the administration of TXA as part of osteosynthesis treatment for pertrochanteric fractures using a proximal femoral nail reduces perioperative blood losses and haemorrhage-related complications.
In a two-centre retrospective cohort study, 1 g TXA i.v. was administered preoperatively to 294 patients who had suffered from pertrochanteric femoral fractures. The subjects were compared clinically to a historical control group who did not receive TXA (nonTXA). Outcomes were evaluated on the basis of perioperative blood loss, transfusion requirement, and occurrence of complications.
The TXA group showed evidence of a reduction in blood loss (TXA = 0.97 ± 0.47 l; nonTXA = 1.06 ± 0.47 l; p = 0.004) and a lower frequency of transfusion (TXA = 20%; nonTXA = 31%; p = 0.032) as compared to the nonTXA group. However, evidence of this therapeutic effect could only be demonstrated at one of the centres on subgroup comparison between the two centres. At the second centre, the data did not show a significant difference. A trend could be seen towards a reduction in postoperative renal failure. No complications occurred resulting from the administration of tranexamic acid.
Preoperative administration of TXA does not lead to an increased rate of thromboembolic complications when applied for treatment of pertrochanteric femoral fractures. Evidence of a positive effect could be seen in principle in relation to the reduction in perioperative blood loss and the frequency of transfusion. The difference in effect between the two centres remains to be clarified: for this reason, it is possible to assume that further factors influencing the efficacy of TXA administration are at play which were not taken into account in this study.
股骨转子间骨折的治疗常伴有大量失血。已经证明，关节成形术中应用氨甲环酸（TXA）可减少失血并降低术后并发症的发生率。本研究旨在证明在使用股骨近端髓内钉进行转子间骨折的内固定治疗时，给予 TXA 是否可以减少围手术期失血和与出血相关的并发症。
在一项双中心回顾性队列研究中，将 1g TXA 静脉内给予 294 例股骨转子间骨折患者。将这些患者与未接受 TXA 的历史对照组（非 TXA 组）进行临床比较。根据围手术期失血、输血需求和并发症发生情况评估结果。
与非 TXA 组相比，TXA 组的失血减少（TXA=0.97±0.47l；非 TXA=1.06±0.47l；p=0.004）和输血频率降低（TXA=20%；非 TXA=31%；p=0.032）。然而，在两个中心的亚组比较中，仅在其中一个中心可以证明这种治疗效果。在第二个中心，数据没有显示出显著差异。术后肾衰竭的发生率有降低的趋势。氨甲环酸的使用没有导致并发症发生。
在治疗股骨转子间骨折时，术前应用 TXA 不会增加血栓栓塞并发症的发生率。原则上可以看到在减少围手术期失血和输血频率方面有积极作用。两个中心之间的效果差异仍有待阐明：因此，可以假设在本研究中没有考虑到影响 TXA 给药效果的其他因素。
