Clinical Observation On The Combined Administration Of Intravenous And Topical Tranexamic Acid In The Treadnent Of Femoral Neck Nonunion With Free Vascularized Fibular Grafting

Objective To explore the effect of combined administration of intravenous and topical tranexamic acid(TXA)in the treatment of femoral neck nonunion with free vascularized fibular grafting(FVFG).Method From February 2017 to March 2018,we admitted 38 cases of nonunion of femoral neck requiring FVFG treatment.According to whether to use TXA or not,we set the patients who did not use TXA from February 201 7 to July 2017 as the control group(18 cases),the patients who used TXA from October 201 7 to March 2018 as the TXA group(20 cases).The TXA group received the combined administration of TXA,including the diluted 2g TXA in 100mL normal saline in the incision before the wound was closed in the donor region and the hip incision,and the intravenous administration of 1g TXA before the hip operation.The control group received only the normal saline intravenous injection and washing of the incision.Observation and group data comparison:operation time,perioperative hemoglobin reduction,intraoperative blood loss,drainage volume of hip and fibula donor site on the first day after surgery,24 hour postoperative drainage rate,intraoperative and postoperative blood transfusion rate,Harris hip score(HHS)at preoperative and postoperative 3 months,visual analog scale(VAS)and the occurrence of related complications.Result No matter the hemoglobin loss value,drainage volume of hip and fibula donor site on the first day after surgery in control group was significantly reduced(p<0.05)compared with Group TXA.There was a decrease in the rate of 24 hours postoperative drainage rate in the hip following tranexamic acid administration in the TXA group(35%compared with 0).The rate of drainage in the fibula donor site of TXA group was 100%at 24 hours after operation,while that of the control group was 38.9%at 24 hours after operation(p<0.05).The perioperative blood transfusion rate was reduced across all revisions treated with tranexamic acid(Group TXA,5%compared with 44.4%,p<0.05).On the first day after operation,the VAS pain score of TXA group was similar to that of the control group,which was 5.7±2.3 and 6.2±2.2 respectively,and the HHS score of TXA group and the control group were also similar,which was 82.5±10 and 81.7±11.9 respectively,with statistical significance(p<0.05).There were no thrombus related complications in TXA group or the control group.Conclusion Compared with the group without TXA,the combination of topical and venous application of TXA can effectively reduce blood loss and blood transfusion demand,improve the rate of 24-hour postoperative drainage rate;in the fibula donor site,the placement of drainage tubes can be reduced.And with no significant increased incidence of thromboembolism and other complications.