Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China.
Graduate School of Dalian Medical University, Dalian, China.
J Neurol Surg A Cent Eur Neurosurg. 2024 May;85(3):280-287. doi: 10.1055/s-0043-1769127. Epub 2023 Aug 16.
Tranexamic acid (TXA) is safe and effective in preventing bleeding during spinal surgery. However, there is currently no relevant research on the efficacy and safety of adding TXA to the saline irrigation fluid in percutaneous endoscopic interlaminar diskectomy (PEID). This study aimed to evaluate the efficacy and safety of topical saline irrigation with TXA for PEID in the treatment of lumbar disk herniation.
In this single-center, retrospective cohort study, patients who underwent PEID for L5-S1 lumbar disk herniation were included and allocated to two groups according to whether they had been administered TXA. PEID was performed with saline irrigation fluid containing 0.33 g of TXA per 1 L of saline in the TXA group ( = 38). In the control group ( = 51), the saline irrigation fluid was injected with the same volume of normal saline. All PEIDs were performed by the same spine surgery team. The hidden blood loss (HBL), intraoperative blood loss (IBL), total blood loss (TBL), amount of fluid used, operation time, visual clarity, hospital stay, blood transfusion rate, coagulation index, and complication rate were compared between the two groups.
The TBL, HBL, and IBL in the TXA group were significantly lower than those of the control group. The postoperative hemoglobin in the TXA group was significantly higher than that of the control group. Visual clarity was significantly better and the operation time was significantly shorter in the TXA group. However, there was no significant difference in postoperative hematocrit, blood coagulation function, amount of fluid used, blood transfusion rate, and perioperative complications between the two groups.
In PEID, the addition of TXA to topical saline irrigating fluid can significantly reduce the HBL, IBL, and TBL. The addition of TXA to topical saline irrigating fluid can improve visual clarity in the surgery and reduce operation time, but it does not change the coagulation function or the complication rate.
氨甲环酸（TXA）在预防脊柱手术出血方面安全有效。然而，目前尚无关于在经皮内窥镜下椎间盘切除术（PEID）中添加 TXA 到盐水灌洗液中治疗腰椎间盘突出症的相关研究。本研究旨在评估 TXA 局部盐水灌洗在治疗 L5-S1 腰椎间盘突出症的 PEID 中的疗效和安全性。
这是一项单中心、回顾性队列研究，纳入了接受 L5-S1 腰椎间盘突出症行 PEID 的患者，并根据是否给予 TXA 将其分为两组。TXA 组（n=38）使用含有 0.33 g TXA/L 生理盐水的灌洗液进行 PEID；对照组（n=51）则使用相同体积的生理盐水进行灌洗。所有的 PEID 均由同一位脊柱外科手术团队进行。比较两组间隐性失血量（HBL）、术中失血量（IBL）、总失血量（TBL）、灌洗液用量、手术时间、术野清晰度、住院时间、输血率、凝血指标及并发症发生率。
TXA 组的 TBL、HBL 和 IBL 均明显低于对照组。TXA 组术后血红蛋白明显高于对照组。TXA 组术野清晰度明显更好，手术时间明显更短。但两组术后血细胞比容、凝血功能、灌洗液用量、输血率及围术期并发症发生率无显著差异。
在 PEID 中，添加 TXA 到局部盐水灌洗液中可显著减少 HBL、IBL 和 TBL。添加 TXA 到局部盐水灌洗液可改善手术视野清晰度，缩短手术时间，但不会改变凝血功能或并发症发生率。
