Analysis Of The Curative Effect Of Different Ways Of Tranexamic Acid In Multisegmental Lumbar Decompression And Fusion

Background:With the increase of population age.the incidence of degenerative lumbar spinal stenosis and degenerative scoliosis is increasing year by year.Spinal decompression and fusion has always been a common method for the treatment of degenerative spinal diseases and a variety of complex spinal diseases.Multi-segmental spinal fusion requires a Iong operation time,accompanied by a large number of soft tissue stripping and blood loss,which directly leads to allogeneic blood transfusion.Excessive bleeding often affects the management of complications and increases the length and cost of hospitalization.The existing measures for bleeding are still very limited,and there are many scholars who are looking for new techniques and methods to reduce the amount of intraoperative bleeding.Autologous blood retention,autologous blood transfusion and so on are commonly used methods at present.In addition,antifibrinolytic drugs have been used in various studies to control acute bleeding and reduce the need for blood transfusions in surgical patients.The use of Tranexamic acid(TXA)can reduce perioperative bleeding without increasing the risk of complications,which is particularly important for spinal surgery.In another study,a similar vein effect was reported in local use of TXA.This paper is to evaluate the different effects of different methods in multi-segmental spinal decompression and fusion.Objective:According to the results of multilevel laminar decompression fusion in patients with degenerative lumbar stenosis and degenerative scoliosis diagnosed in our hospital,the treatment results of(TXA)were collected and analyzed to evaluate the clinical efficacy and safety of tranexamic acid in reducing perioperative blood loss during major spinal surgery,and to provide theoretical basis for the application of tranexamic acid in spinal surgery.Methods:The data of patient diagnosed as degenerative scoliosis or degenerative lumbar spinal stenosis(DLSS)in our department from October 2016 to June 2018 were retrospectively analyzed.The data of 240 patients(113 males and 127 females,aged 49-78 years,mean age 65.6±10.3 years)and body mass index 21.37?32,o6kg/m2,BMI 23.8 ±4.6kg/m2)were collected according to the set inclusion criteria.All patients were treated with posterior laminar decompression and fusion with three or more segments,including 141 cases with three segments,72 cases with four segments and 20 cases with five segments.240 cases were randomly divided into four groups:group A?B?C and D,60 cases in each group.Group A was combination therapy group(TXA was used locally in both preoperative and postoperative incisions);Group B is venous group(Intravenous application of TXA only before operation);Group C is a local group(Application of TXA in simple postoperative incision);D group was control group(Do not apply TXA).The patients in group A were injected with lg TXA from vein before skin incision 1smin and 20mlNS?lgTXA into the incision from drainage tube,then keep the drainage tube closed two hours,The patients in group B were injected with lgTXA from vein before skin incision 15min and 20ml NS into the incision from drainage tube,then keep the drainage tube closed two hours.The patients in group C should has not been used TXA previously and injected 20mINS+lgTXA into the incision from drainage tube,then keep the drainage tubeclosed two hours.The patients in group D should has not been used TXA previously and were injected 20mINS into the incision from drainage tube,then keep the drainage tubeclosed two hours.The data were collected and analyzed by SPSS 19.0 software,p<0.05 was statistically significant.Result:Effective statistics were performed on all patients after entering the group.The intraoperative blood loss in the three-segment fusion group(296ml±46ml)was lower than that in the control group(296ml±54ml)(p<0.05).The postoperative bleeding volume in the local group(198ml±30ml)was lower than that in the venous group and the control group(p<0.05).The total bleeding volume in the combined group(390ml±54ml)was lower than that in the other three groups(P<0.05).The amount of postoperative in the combined group bleeding was similar to that of the local group,and there was no significant difference between the two groups.The results of four-segment fusion and five-segment fusion surgery were the same as those of three-segment fusion operation.The postoperative blood transfusion rate in the combined group(5%)was significantly lower than that in the other three groups(P<0.05).There was no significant difference in the incidence and distribution of DVT,PE and common complications among the three groups(P>0.05).Conclusion:In spinal decompression and fusion,intravenous application of tranexamic acid was of significance in reducing the amount of blood loss during operation,but had little effect on the amount of blood loss after operation.Local application of TXA can reduce postoperative bleeding.The two methods have complementary effects and do not increase the incidence of complications.