Tanghe Kira K, Chalmers Brian P, Blevins Jason L, Figgie Mark P, Carli Alberto V, Agrusa Christopher J, Sculco Peter K, Gausden Elizabeth B
Albert Einstein College of Medicine, Bronx, NY, USA.
Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA.
HSS J. 2023 May;19(2):247-253. doi: 10.1177/15563316221134270. Epub 2022 Nov 14.
Controlling blood loss is a crucial aspect of orthopedic surgery. Hemostatic agents can be used intraoperatively in combination with antifibrinolytics as part of an overall strategy to limit blood loss. Several new hemostatic agents have recently come to the market designed specifically for vascular surgery but have found uses in other surgical fields, including orthopedics. This article reviews the mechanisms of action and best uses of various mechanical hemostats, active hemostats, flowable hemostats, and fibrin sealants for achieving hemostasis in orthopedic surgery. Mechanical and active hemostats have been reported to successfully decrease blood loss from cancellous bone, capillaries, and venules. Flowable hemostats are generally favorable for use in small spaces where the swelling capabilities of mechanical and active hemostats can be detrimental to surrounding structures. Sealants are best used for closing defects in tissues.
控制失血是骨科手术的一个关键方面。止血剂可在术中与抗纤维蛋白溶解剂联合使用，作为限制失血的整体策略的一部分。最近有几种专门为血管手术设计的新型止血剂进入市场，但已发现其可用于包括骨科在内的其他外科领域。本文综述了各种机械止血剂、活性止血剂、可流动止血剂和纤维蛋白密封剂在骨科手术中实现止血的作用机制和最佳用途。据报道，机械止血剂和活性止血剂可成功减少松质骨、毛细血管和小静脉的失血。可流动止血剂通常有利于在小空间使用，因为机械止血剂和活性止血剂的膨胀能力可能会对周围结构造成损害。密封剂最适合用于封闭组织缺损。
