Objective To compare the effect and safety of topical tranexamic acid(TTA)and intravenous tranexamic acid(IVTA) reducing the hidden blood loss after femoral intertrochanteric fracture fixation with proximal femoral nail antirotation. Methods Eighty-two patients treated by PFNA were randomly divided into two groups. For patients in TTA groups(n=42)group,2g tranexamic acid dissolved in 20ml normal saline was injected into the femur medullary cavity after proximal femur reaming. For patients in IVTA group(n=40),tranexamic acid(15mg/kg, maximum1.2g)was used at the induction of anaesthesia. Then the blood loss,blood transfusion rate,hemoglobin(HB)concentration and hematocrit (HCT)drop,complications of each group were compared. Results There was no significant difference between the two groups(P>0.05).In both groups no deep vein thrombosis or other complications was found. Conclusion Compared with intravenous tranexamic acid,topical tranexamic acids also effective in reducing the blood loss and the need for blood transfusion following PFNA,with little or no systemic absorption and subsequent systemic side effects,theoretically.%目的 比较局部和静脉应用氨甲环酸对减少股骨转子间骨折PFNA内固定术后隐性失血的有效性和安全性.方法 82例股骨转子间骨折行PFNA内固定术患者随机分为两组,局部应用组(n=42)患者在近端扩髓后骨髓腔内注入氨甲环酸(2g溶于20ml生理盐水),静脉应用组(n=40)患者在术前30min静脉输注氨甲环酸(15mg/kg,最大剂量1.2g).主要观察指标包括显性失血量、隐性失血量、输血率、术后次日血红蛋白(HB)和红细胞压积(HCT)值变化、并发症,并作统计学分析.结果 两组间术前平均HB,平均HCT,术后次日平均HB,平均HCT,显性失血量,隐性失血量,输血人数对比无显著性差异(P>0.05).两组患者均未出现有症状的下肢深静脉栓塞及肺栓塞并发症.结论 与静脉应用相比,近端扩髓后骨髓腔内局部应用氨甲环酸同样能够有效减少隐性失血和输血,理论上避免了静脉应用氨甲环酸可能带来的全身并发症.
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