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[医用可吸收止血材料在骨科手术止血中的应用进展]

[Progress in application of medical absorbable haemostatic materials for haemostasis in orthopaedic surgery].

作者信息

Wang Gang, Zeng Yi

机构信息

Department of Orthopaedics, Institute of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Nov 15;38(11):1421-1426. doi: 10.7507/1002-1892.202405068.

DOI:10.7507/1002-1892.202405068
PMID:39542637
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11563752/
Abstract

OBJECTIVE

The application progress of medical absorbable haemostatic material (MAHM) in hemostasis during orthoapedic surgery was reviewed, in order to provide reference for clinical hemostasis program.

METHODS

The domestic and foreign literature on the application of MAHM for hemostasis in orthopedic surgery was extensively reviewed and summarized.

RESULTS

According to biocompatibility, MAHM can be divided into oxidized cellulose/oxidized regenerated cellulose materials, chitosan and its derivatives materials, starch materials, collagen and gelatin materials, and fibrin glue materials, , which can effectively reduce blood loss when used in orthopedic surgery for hemostasis. Each hemostatic material has different coagulation mechanism and suitable population. Oxidized cellulose/oxidized regenerated cellulose, chitosan and its derivatives, starch hemostatic material mainly stops bleeding by stimulating blood vessel contraction and gathering blood cells, which is suitable for people with abnormal coagulation function. Collagen, gelatin and fibrin glue hemostatic materials mainly affect the physiological coagulation mechanism of the human body to stop bleeding, suitable for people with normal coagulation function.

CONCLUSION

Reasonable selection of MAHM can effectively reduce perioperative blood loss and reduce the risk of postoperative complications, but at present, single hemostatic material can not meet clinical needs, and a new composite hemostatic material with higher hemostatic efficiency needs to be developed.

摘要

目的

综述医用可吸收止血材料在骨科手术止血中的应用进展,为临床止血方案提供参考。

方法

广泛查阅并总结国内外关于医用可吸收止血材料在骨科手术止血中应用的文献。

结果

根据生物相容性,医用可吸收止血材料可分为氧化纤维素/氧化再生纤维素材料、壳聚糖及其衍生物材料、淀粉材料、胶原蛋白和明胶材料以及纤维蛋白胶材料,这些材料用于骨科手术止血时可有效减少失血。每种止血材料的凝血机制不同,适用人群也不同。氧化纤维素/氧化再生纤维素、壳聚糖及其衍生物、淀粉止血材料主要通过刺激血管收缩和聚集血细胞来止血,适用于凝血功能异常的人群。胶原蛋白、明胶和纤维蛋白胶止血材料主要影响人体的生理凝血机制来止血,适用于凝血功能正常的人群。

结论

合理选用医用可吸收止血材料可有效减少围手术期失血,降低术后并发症风险,但目前单一止血材料无法满足临床需求,需要研发止血效率更高的新型复合止血材料。

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本文引用的文献

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Hemostatic effect and safety evaluation of oxidized regenerated cellulose in total knee arthroplasty- a randomized controlledtrial.氧化再生纤维素在全膝关节置换术中的止血效果及安全性评估——一项随机对照试验
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[Research Progress of Carboxymethyl Chitosan-Based Haemostatic Materials and Their Haemostatic Mechanism --Review].[羧甲基壳聚糖基止血材料的研究进展及其止血机制——综述]
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2023 Jun;31(3):911-915. doi: 10.19746/j.cnki.issn.1009-2137.2023.03.044.
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Bioabsorbable Carboxymethyl Starch-Calcium Ionic Assembly Powder as a Hemostatic Agent.可生物吸收的羧甲基淀粉-钙离子组装粉末作为止血剂
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Is It an Outbreak of Health Care-Associated Infection? An Investigation of Binocular Conjunctival Congestion After Laparoscopic Cholecystectomy Was Traced to Chitosan Derivatives.这是一起医疗保健相关感染的爆发事件吗?对腹腔镜胆囊切除术后双眼结膜充血的调查发现与壳聚糖衍生物有关。
Front Med (Lausanne). 2022 Mar 7;9:759945. doi: 10.3389/fmed.2022.759945. eCollection 2022.
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Topical hemostatic materials for coagulopathy.用于凝血功能障碍的局部止血材料。
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Chitosan Derivatives and Their Application in Biomedicine.壳聚糖衍生物及其在生物医学中的应用。
Int J Mol Sci. 2020 Jan 12;21(2):487. doi: 10.3390/ijms21020487.
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Low haemoglobin at admission is associated with mortality after hip fractures in elderly patients.入院时低血红蛋白与老年髋部骨折患者的死亡率相关。
Bone Joint J. 2019 Sep;101-B(9):1122-1128. doi: 10.1302/0301-620X.101B9.BJJ-2019-0526.R1.
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Internal surgical use of biodegradable carbohydrate polymers. Warning for a conscious and proper use of oxidized regenerated cellulose.可生物降解碳水化合物聚合物的内部外科用途。氧化再生纤维素的使用警示,需注意并正确使用。
Carbohydr Polym. 2019 Jul 15;216:213-216. doi: 10.1016/j.carbpol.2019.04.036. Epub 2019 Apr 9.
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Comparison the efficacy of hemorrhage control of Surgiflo Haemostatic Matrix and absorbable gelatin sponge in posterior lumbar surgery: A randomized controlled study.Surgiflo止血基质与可吸收明胶海绵在腰椎后路手术中止血效果的比较:一项随机对照研究。
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