The Effect Of Tranexamic Acid On Postoperative Drainage After Posterior Lumbar Fusion

Objective:To investigate the effect of intraoperative lavage of tranexamic acid on postoperative drainage after posterior lumbar fusion and the safety of clinical application.Methods:A cohort study was conducted on 61 patients who underwent primary single-segment or double-segment transforaminal lumbar interbody fusion between July 2016 and October 2017.Patients from February to October 2017 were selected as the experimental group(group A),and patients from July 2016 to January 2017 were selected as the control group(group B).After transforaminal lumbar interbody fusion in group A and group B,Before the indwelling drainage tube was placed in the intraoperative cavity,the patients in group A were irrigated with 800ml tranexamic acid and sodium chloride injection in the intraoperative cavity,and the patients in group B were given 0.9%sodium chloride injection 800ml as control.According to the differences in surgical segments and methods of decompression of spinal canal,group A and group B were divided into four subgroups,namely,single segmental fusion unilateral decompression group,single segmental fusion bilateral decompression group,double segmental fusion unilateral decompression group,double segmental fusion bilateral decompression group.Compare the general data,Preoperative hemoglobin,preoperative concentration of D-dimer,intraoperative blood loss,drainage volume on each of the first three days after surgery,postoperative total drainage volume,days of indwelling drainage tube,postoperative hemoglobin,Postoperative concentration of D-dimer and postoperative deep vein thrombosis,pulmonary infarction or myocardial infarction of patients in A and B groups of these four subgroups.Results:Among the patients in group A,there were 15 males and 16 females,A total of 31 patients,aged 29?81 years,with an average age of 53 years.Group B included 14 males and 16 females,a total of 30 patients,aged 20?78 years,with an average age of 54 years.There were no significant differences in age,gender,diagnosis,mean hemoglobin concentration and mean D-dimer concentration between group A and group B preoperatively;There was no significant difference in intraoperative blood loss between the two groups;The indexes of average drainage volume on the first day after surgery,average drainage volume on the second day after surgery,average drainage volume on the third day after surgery,average total postoperative drainage volume,average postoperative extubation time,and average concentration of D-dimer were statistically significant in the subgroup of single segmental fusion unilateral decompression in group A compared with group B(P<0.05),In the three subgroups of single segmental fusion bilateral decompression group,double segmental fusion unilateral decompression group,double segmental fusion bilateral decompression group,there was no statistical difference between group A and group B(P>0.05);There was no significant difference in mean hemoglobin concentration between group A and group B after operation;Postoperative incision healing was grade A in both group A and B;None of the patients developed lower limb deep vein thrombosis,pulmonary infarction,myocardial infarction or other thrombotic events until discharge.ConcIusion:For a single segment of the laminectomy decompression fusion of the transforaminal lumbar interbody fusion,intraoperative irrigation of tranexamic acid can significantly reduce the total postoperative drainage volume and shorten the time of indwelling catheter.And there were no thrombotic events.These are conducive to the rapid recovery of patients?Moreover,sodium chloride tranexamic acid injection is cheap,so it can be widely used in clinical practice.