Sun Ning, Wang Xuewen, Wu Yong, Ren Shuang, Li Heng, DU Hui, Gong Xiaofeng
Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2025 Feb 18;57(1):172-177. doi: 10.19723/j.issn.1671-167X.2025.01.026.
To evaluate the early efficacy of local application of tranexamic acid on the osteotomy surface during hallux valgus surgery in reducing postoperative occult blood loss and thus postoperative swelling.
The data of 40 cases with hallux valgus osteotomy admitted to the Department of Foot and Ankle Surgery of Jishuitan Hospital from July 11, 2022 to October 8, 2022, including 5 males and 35 females were retrospectively analyzed. According to the inclusion and exclusion criteria, 32 cases were finally divided into 16 cases in the observation group (application of tranexamic acid) and 16 cases in the control group (no application of tranexamic acid). The observation group was paired with the control group one by one in accordance with the operation style, and the change in the anterior and posterior diameter of the first metatarsal head, the change in the circumferential diameter of the foot, the length of the first metatarsal midline and the length of the plumbline of the foot measured by postoperative CT were compared between the two groups before and after surgery, in order to evaluate the degree of swelling around the incision after the surgery. The first metatarsal midline and plumb line were measured by reference to the two auxiliary lines that intersect the soft tissue border in the sesamoid bone position to measure the rotation angle of the first metatarsal. A total of three clinicians completed the measurements of these two line segments and interobserver comparisons were performed.
By interobserver comparison, the consistency of the length of the midline of the first metatarsal and the plumbline measured by CT was high and could be considered a reliable measurement. After the paired -test, there was no statistical difference in the amount of changes in the anteroposterior diameter of the first metatarsal before and after surgery between the observation and control groups (>0.05), and the amount of changes in the circumferential diameter of the foot before and after surgery was smaller in the observation group than in the control group, which was statistically significant ( < 0.05); the length of the midline of the first metatarsal and the plumbline of the foot measured by CT after surgery was smaller in the observation group than in the control group, which was statistically significant ( < 0.05).
Local application of tranexamic acid on the osteotomy surface during hallux valgus osteotomy can relieve postoperative swelling to some extent, which may be related to the fact that tranexamic acid reduces occult blood loss in the postoperative period.
评估拇外翻手术中在截骨面局部应用氨甲环酸对减少术后隐性失血及术后肿胀的早期疗效。
回顾性分析2022年7月11日至2022年10月8日积水潭医院足踝外科收治的40例拇外翻截骨患者资料，其中男性5例，女性35例。根据纳入和排除标准，最终将32例患者分为观察组（应用氨甲环酸）16例和对照组（未应用氨甲环酸）16例。观察组与对照组按照手术方式一一配对，比较两组手术前后术后CT测量的第一跖骨头前后径变化、足周径变化、第一跖骨中线长度及足垂线长度，以评估术后切口周围肿胀程度。第一跖骨中线和垂线是参照在籽骨位置与软组织边界相交的两条辅助线来测量第一跖骨的旋转角度。共有三名临床医生完成这两条线段的测量并进行观察者间比较。
经观察者间比较，CT测量的第一跖骨中线和垂线长度一致性高，可认为测量可靠。配对检验后，观察组和对照组术后第一跖骨前后径变化量差异无统计学意义（>0.0５），观察组术后足周径变化量小于对照组，差异有统计学意义（<0.05）；观察组术后CT测量的第一跖骨中线长度和足垂线长度小于对照组，差异有统计学意义（<0.05）。
拇外翻截骨术中在截骨面局部应用氨甲环酸可在一定程度上减轻术后肿胀，这可能与氨甲环酸减少术后隐性失血有关。
