Wang Gang, Zeng Yi
Department of Orthopaedics, Institute of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Nov 15;38(11):1421-1426. doi: 10.7507/1002-1892.202405068.
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.
The domestic and foreign literature on the application of MAHM for hemostasis in orthopedic surgery was extensively reviewed and summarized.
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.
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.
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。
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。
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。
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。