BACKGROUND: Proximal femoral nail anti-rotation is widely used to treat various intertrochanteric fractures. Although its operation trauma is small, and the blood loss of perioperative period is still large. Tranexamic acid has been gradually used to reduce the bleeding of intertrochanteric fracture. The effectiveness and safety of reducing blood loss during perioperative period were not reported. OBJECTIVE: To explore the safety and efficacy of tranexamic acid on perioperative blood loss in patients with intertrochanteric fracture undergoing proximal femoral nail anti-rotation. METHODS: One hundred and eight patients with intertrochanteric fracture undergoing proximal femoral nail anti-rotation were selected from First Affiliated Hospital, Guangzhou University of Chinese Medicine between January 2015 and January 2017. Among all the subjects, 52 patients who received the operation before January 2016 served as the control group and 56 patients who received the operation after January 2016 were selected as the treatment group. Half an hour before operation, patients in the treatment group received 1 g tranexamic acid dissolved in 250 mL normal saline by intravenous dropping; patients in the control group just received 250 mL normal saline by intravenous dropping. The bleeding volume, blood transfusion volume, hemoglobin, hematocrit, coagulation index, D-dimer levels and complications were compared between the two groups. RESULTS AND CONCLUSION: (1) During perioperative period, actual blood loss, intraoperative blood loss, dominant blood loss, recessive blood loss, volume of drainage, blood transfusion volume and blood transfusion rate were lower in the treatment group than in the control group (P < 0.05). (2) There was no statistically significant difference in the hemoglobin and hematocrit between the two groups before operation (P > 0.05). The hemoglobin and hematocrit of the two groups gradually decreased after the operation, and there was a slight improvement in the fifth day after surgery. At postoperative 2 hours, 1, 3 and 5 days, the hemoglobin and hematocrit of the treatment group were higher than in the control group (P < 0.05). At preoperation and each time point postoperation, prothrombin time, activated partial thromboplastin time, and fibrinogen levels were not statistically significant between the two groups (P > 0.05). Postoperative D-dimer levels in the two groups were significantly higher than preoperation, and there was a return on the fifth day. There was no statistically significant difference between groups at preoperation and each time point of postoperation (P > 0.05). (3) The results suggest that the tranexamic acid can effectively reduce the dominant and recessive blood loss in patients with the intertrochanteric fracture, and it is safe and effective.%背景:股骨近端防旋髓内钉被广泛用于治疗各类转子间骨折,虽然其手术创伤小,但围术期的出血量仍较大,氨甲环酸目前已逐渐被用于降低股骨转子间骨折围术期失血,其降低围术期失血的有效性及其安全性尚缺乏文献报道.目的:探讨氨甲环酸降低股骨转子间骨折股骨近端防旋髓内钉内固定围术期失血的安全性及有效性.方法:纳入2015年1月至2017年1月在广州中医药大学第一附属医院就诊的股骨转子间骨折且接受股骨近端防旋髓内钉内固定治疗的108例患者,2016年1月以前52例患者为对照组,2016年1月以后56例患者为试验组.试验组于术前半小时使用氨甲环酸1 g稀释于250 mL生理盐水中静脉滴注.对照组术前半小时予250 mL生理盐水静滴,比较2组患者股骨近端防旋髓内钉内固定前后各种出血量、输血情况、血红蛋白量、红细胞比容、凝血指标、D-二聚体水平及并发症发生情况.结果与结论:①围术期指标:试验组的患者在住院期间围手术期的实际失血量、术中失血量、显性失血量、隐性失血量、引流量、输血量和输血率均低于对照组(P < 0.05);②血液生化指标:手术内固定前两组患者的血红蛋白及红细胞比容差异无显著性意义(P > 0.05),两组患者术后血红蛋白及红细胞比容均较术前逐渐降低,在术后第5天时较前稍有回升,两组间术后2 h,1 d,3 d,5 d的时间点上比较,试验组的血红蛋白值及红细胞比容均高于同时间点对照组(P < 0.05),手术内固定前后各时间点两组患者的凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原水平均差异无显著性意义(P > 0.05),两组患者手术内固定后D-二聚体水平均较术前明显升高,在术后第5天有所回降,各时间点组间比较差异无显著性意义(P > 0.05).③结果提示,氨甲环酸能有效降低股骨转子间骨折股骨近端防旋髓内钉内固定患者围术期的显性失血和隐性失血,且安全有效.
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