High-dose Tranexamic Acid To Reduce Blood Loss In Hemivertebra Resection For Early Onset Scoliosis Of Children:A Randomized Controlled Trial

Objective: The purpose of this study was to assess the effectiveness and safety of high-dose of TXA used in EOS of children treated with hemivertebra resection and posterior fusion surgery.Methods: Sixty-ninth EOS under 10 years treated with single hemivertebra resection and posterior fusion surgery in the Orthopaedics Department of the Second Affiliated Hospital of Kunming Medical University were from February 2013 to March 2017 ware selected in this study.These patients randomly divided into TXA proup arid placebo group. The TXA group including 35 patients and given with a loading dose of TXA at 100mg/kg with a maintenance dose of TXA at 10mg/kg/h, the placebo group including 34 patients and given with 0.9% saline.All procedures were performed by the same surgeon and anesthetist.All patients were treated with single hemivertebra resection.All patients under 3 years were treated with 2 segments fusion, and the patients older than 3 yesrs were treated with 2～7 segments fusion which depend on the degree of the deformity. The intraopertive blood loss, real blood loss (blood loss/blood volume×100%) and blood transfusion were assessed. The complications,such as renal toxicity, deep venous thrombosis (DVT), acute myocardial infarction(AMI), arrhythmia and seizure, were also assessed.Results:① There were no significant differences in age、sex、weight、blood volume、operation time or fusion levels between two groups(P>0.05); Compared the above indexes of patients under 3 years、 between 3 and 6 years and older than 6 years between two groups respectively, no significant differences also (P>0.05).② The TXA group had significantly less intraoperative blood loss [ (385±181) ml]and real blood loss [ (26.1 ±9.6) %] than placebo group [ (588± 171) ml,(40.5±7.6)%, respectively , P<0.05].③ The TXA group received significantly less intraoperative blood transfusion than placebo group[ (349±141) ml vs (495±177) ml, P<0.05].④ In the TXA group,all of the patients under 3 years.between 3 and 6 years and older than 6 years had significantly less intraoperative blood loss,real blood loss and blood transfusion than placebo group (P<0.05) .⑤ There were no significant differences in the test value of hemoglobin, hematokrit,prothrombin time(PT),activated partial thromboplastin time(APTT),Fibrinogen(FIB),International Normalized Ratio (INR) ,Aspartate aminotransferase(AST),Alanine aminotransferase(ALT) or Serum Creatinine(Scr) of Preoperative or 1st Day after surgery and the intraoperative urine output bwtween two group (P>0.05 ) ; There were no significant differences in the appeal indicators of the patients under 3 years 、between 3 and 6 years and older than 6 years bwtween two group (P>0.05 ) 。⑥ There were no DVT, AMI, arrhythmia and seizure in all patients.Conclusions: In EOS of children treated with hemivertebra resection, high-dose TXA can significantly reduce intraoperative blood loss, real blood loss and blood transfusion.; Is safe and effective.