| Background and purposeIntertrochanteric fractures of the femur are one of the most common types of fractures in the elderly.The intertrochanteric part is mainly composed of cancellous bone,with rich blood supply,and fractures are often accompanied by massive bleeding.Tranexamic acid is a commonly used hemostatic drug,which plays an important role in reducing perioperative blood loss and the incidence of postoperative complications.This study evaluated the hemostatic effect and safety of tranexamic acid(TXA)administrated through different methods in perioperative period of artificial femoral head replacement for treating unstable intertrochanteric fractures of the femur in the elderly,provided a new method for the clinical application of tranexamic acid,reduced the postoperative complications,promoted recovery.Material and methodsCollected clinical and follow-up data of 105 patients with fresh unstable intertrochanteric fresh fractures admitted to Huaihe Hospital of Henan University from January 2018 to July 2019,all of those patients were treated with bone cement type bipolar artificial femoral head replacement.According to the different administration,those patients were divided into three groups: Intravenous injection group,local perfusion group and control group.Intravenous injection group were treated with 1.0g TXA through intravenous injection before skin incision,three hours after the operation,1g of TXA was injected intravenously again;local perfusion group were treated with 2.0g TXA through perfusion into the wound space;control group were treated no TXA but 250 ml saline solution instead.Compared the total blood loss,hidden blood loss and blood transfusion rate among the 3 groups.And then compared the hematocrit,hemoglobin level,C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)in these 3 groups of patients before and after operation.Recorded the occurrence of complications such as fever and lower limb venous thrombosis in 3 groups.All the data was summarized and statistically analyzed.ResultsThe perioperative blood loss in the intravenous injection group,local perfusion group,and controlgroup were(689.6 ± 120.5)m L,(707.7 ± 115.5)m L,(920.8 ± 110.9)m L,respectively.The hidden blood loss were(584.5 ± 47.5)m L,(596.5 ± 43.8)m L,(788.5 ± 41.7)m L.Compared with the control group,the total perioperative blood loss and the hidden blood loss were significantly lower(P <0.05).The dominant blood loss was(105.5 ± 42.5)m L,(111.5 ± 43.8)m L,(108.5 ± 41.7)m L,respectively.There was no statistically significant difference among these 3 groups(P> 0.05).The blood transfusion rates of the intravenous injection group,local perfusion group,and control group were 11.1%,13.3%,and 36.9%,respectively.Compared with the control group,the blood transfusion rates of the intravenous injection group and the local perfusion group were significantly reduced(P < 0.05),there was no significant difference between intravenous treatment group and local perfusion group.At 3 h,1 d,and 3 d after operation,the C-reactive protein and erythrocyte sedimentation rate of patients gradually increased,and the expression levels were much higher in the control group,the difference was statistically significant(P <0.05).There was no significant difference in the incidence of DVT between the intravenous injection group and the local perfusion group(P>0.05),and no PE occurred in any group.Conclusion(1)Tranexamic administrated by intravenous infusion or local wound cavity infusion could significantly reduce the blood loss,especially the hidden blood loss.The dominant blood loss was not influenced significantly.Tranexamic could also reduce the blood transfusion rate after artificial femoral head replacement for unstable intertrochanteric fractures(2)Local infusion of 2 g TXA in artificial femoral head replacement cannot achieve the same hemostatic effect as intravenous injection of 2 g TXA.(3)TXA did not increase the incidence of postoperative deep vein thrombosis,pulmonary embolism or other complications. |
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