Graif Nadav, Warschawski Yaniv, Amzallag Nissan, Zarour Shiri, Ben-Tov Tomer, Snir Nimrod, Khoury Amal, Ashkenazi Itay
Department of Orthopedic Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel.
Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel Aviv, Israel.
Eur J Orthop Surg Traumatol. 2025 Sep 4;35(1):380. doi: 10.1007/s00590-025-04504-0.
To evaluate the effect of intraoperative tranexamic acid (TXA) on perioperative blood loss, transfusion requirements, and clinical outcomes in patients undergoing proximal femoral nailing (PFN) for intertrochanteric fractures.
A retrospective cohort study of 1,728 patients who underwent PFN fixation for intertrochanteric fractures between 2017 and 2024. Perioperative hemoglobin (Hb) dynamics, transfusion requirements, and clinical outcomes were compared between patients receiving 1-1.5 g intravenous TXA (n = 1,446) and controls (n = 282).
The TXA group demonstrated reduced perioperative Hb decline (2.15 ± 1.40 vs 2.76 ± 1.57 g/dL, p < 0.001) and lower rates of Hb drop > 2 g/dL (47.9% vs 63.5%, OR 0.53, p < 0.001). TXA administration was associated with decreased transfusion requirements (7.1% vs 11.0%, p = 0.021). Multivariate analysis confirmed TXA as an independent protective factor against blood loss. Mortality rates showed no significant difference between groups.
Intraoperative TXA during PFN fixation was associated with reduced perioperative blood loss and transfusion requirements. These findings support TXA as an effective blood conservation strategy in elderly patients with intertrochanteric fractures.
评估术中使用氨甲环酸（TXA）对接受股骨近端髓内钉（PFN）治疗转子间骨折患者围手术期失血、输血需求及临床结局的影响。
对2017年至2024年间接受PFN固定治疗转子间骨折的1728例患者进行回顾性队列研究。比较接受1-1.5克静脉注射TXA的患者（n = 1446）和对照组（n = 282）的围手术期血红蛋白（Hb）动态变化、输血需求及临床结局。
TXA组围手术期Hb下降幅度减小（2.15±1.40 vs 2.76±1.57 g/dL，p < 0.001），Hb下降>2 g/dL的发生率较低（47.9% vs 63.5%，OR 0.53，p < 0.001）。使用TXA与输血需求减少相关（7.1% vs 11.0%，p = 0.021）。多因素分析证实TXA是预防失血的独立保护因素。两组死亡率无显著差异。
PFN固定术中使用TXA与围手术期失血和输血需求减少相关。这些发现支持TXA作为老年转子间骨折患者有效的血液保护策略。
