Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA.
BMC Musculoskelet Disord. 2023 Aug 29;24(1):686. doi: 10.1186/s12891-023-06811-1.
Tranexamic acid (TXA) has been widely used in orthopedic surgery, but its efficacy in adolescent scoliosis (AS) surgery remains unclear in the literature. The purpose of this systematic review and meta-analysis is to evaluate the safety and efficacy of TXA compared to placebo treatment during or after AS surgery, by gathering data from randomized both controlled trials (RCTs) and non-RCTs.
English and Chinese electronic databases including PubMed, Web of Science, Embase, Cochrane, CNKI, and Wan Fang database were searched to identify the relevant literature up until August 2022. The primary outcomes were intraoperative blood loss and total blood loss. The secondary outcomes included the need for transfusion, postoperative hemoglobin (Hb) level, and change in Hb level. Stata 17 was used for data analysis and the risk of bias was assessed. We followed the PRISMA checklist to ensure the quality of this article.
Twelve studies (795 participants) were included in the meta-analysis for intraoperative blood loss during surgery. The results suggest that TXA can reduce the intraoperative blood loss of the patients (MD = -306.40ml, 95%CI = -404.04ml to -208.77ml, p < 0.001). Six studies (2027 patients) were included in the meta-analysis for total blood loss. The pooled result shows that the total blood loss of the TXA group was significantly lower than that of the control group (MD = -779.24ml, 95% CI = -1157.10ml to -410.39ml, p < 0.001). Five studies (419 patients) were included in the meta-analysis for postoperative Hb level and shows a non-significant outcome (MD = 5.09 g/l, 95%CI = 2.92 g/l to 7.25 g/l, p = 0.611). Three studies (268 patients) were included in the meta-analysis for the postoperative Hb level. There is a non-significant decrease in the TXA group (MD = -0.23 g/l, 95%CI = -0.48 g/l to 0.01 g/l, p = 0.319). Eight studies (670 patients) reported data on the need for transfusion after surgery. The overall relative risks (RR) showed a significant difference between the TXA and control group, with a lower risk of transfusion in the TXA group (RR = 0.547, 95%CI = 0.308 to 0.972, p = 0.04).
The meta-analysis of the data reveals that TXA usage is associated with a significant reduction in intraoperative and total blood loss, a lower risk of transfusion, and a non-significant change in postoperative Hb levels in AS surgery However, it should be noted that the surgical operation situations varied across different studies. Therefore, further research is required to investigate the effects of TXA on specific subgroups of gender, operation time, and blood transfusion indicators. Overall, our study provides valuable evidence for the clinical management of AS surgery and may inform the development of practice guidelines and protocols for the use of TXA in this setting.
氨甲环酸（TXA）在骨科手术中已得到广泛应用，但在青少年脊柱侧凸（AS）手术中的疗效在文献中尚不清楚。本系统评价和荟萃分析的目的是通过收集来自随机对照试验（RCT）和非 RCT 的数据，评估 TXA 与安慰剂治疗在 AS 手术期间或之后的安全性和疗效。
检索了包括 PubMed、Web of Science、Embase、Cochrane、CNKI 和万方数据库在内的英文和中文电子数据库，以确定截至 2022 年 8 月的相关文献。主要结局是术中失血量和总失血量。次要结局包括输血需求、术后血红蛋白（Hb）水平和 Hb 水平变化。使用 Stata 17 进行数据分析，并评估偏倚风险。我们遵循 PRISMA 清单以确保本文的质量。
荟萃分析纳入了 12 项研究（795 名参与者），以评估手术期间术中失血量。结果表明，TXA 可减少患者的术中失血量（MD=-306.40ml，95%CI=-404.04ml 至-208.77ml，p<0.001）。荟萃分析纳入了 6 项研究（2027 名患者），以评估总失血量。汇总结果表明，TXA 组的总失血量明显低于对照组（MD=-779.24ml，95%CI=-1157.10ml 至-410.39ml，p<0.001）。荟萃分析纳入了 5 项研究（419 名患者），以评估术后 Hb 水平，结果显示无显著差异（MD=5.09 g/l，95%CI=2.92 g/l 至 7.25 g/l，p=0.611）。荟萃分析纳入了 3 项研究（268 名患者），以评估术后 Hb 水平。TXA 组的 Hb 水平呈非显著下降（MD=-0.23 g/l，95%CI=-0.48 g/l 至 0.01 g/l，p=0.319）。8 项研究（670 名患者）报告了术后输血需求的数据。总体相对风险（RR）显示 TXA 组和对照组之间存在显著差异，TXA 组输血风险较低（RR=0.547，95%CI=0.308 至 0.972，p=0.04）。
对数据的荟萃分析表明，TXA 的使用与术中及总失血量的显著减少、输血风险的降低以及 AS 手术中术后 Hb 水平的非显著变化相关。然而，应该注意的是，不同研究的手术操作情况存在差异。因此，需要进一步研究 TXA 对特定亚组（性别、手术时间和输血指标）的影响。总的来说，本研究为 AS 手术的临床管理提供了有价值的证据，并可能为 TXA 在该领域的使用制定临床实践指南和方案提供信息。
