| Objective:To study intravenous application,topical application and combined application of three different ways to apply tranexamic acid(TXA)to degenerative lumbar spinal stenosis that requires modified transforaminal lumbar interbody fusion(TLIF)The effect of degenerative lumbar spinal stenosis(DLSS)in patients with perioperative bleeding,to evaluate the effectiveness and safety of its application in this type of surgery,and to provide clinical reference.Methods: From November 2019 to January 2021,80 patients with lumbar spinal stenosis who were hospitalized in the Department of Spine Surgery of Sichuan Orthopaedic Hospital and combined with modified TLIF surgery were collected.The patients were divided into four groups using a random number table method: intravenous group and local area.Group,combination group and control group.Statistics of intraoperative blood loss in each group,postoperative drainage,total blood loss after operation,red blood cell,hemoglobin,hematocrit,platelet,coagulation five items + fibrinogen before operation and on the 1st and 3rd day after operation Degradation products(FDP)+ D-dimer(DD),color Doppler ultrasound results of both lower extremity veins before surgery and 1 day before discharge,postoperative complications,etc.;the results before surgery and the first and third days after surgery are inter-group And comparison within the group.Results: 1.There was no significant difference in age,gender,height,and weight of patients in each group(P>0.05);2.The intraoperative blood loss in the intravenous group and the combined group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05),while the intraoperative blood loss between the local group and the control group was not statistically different(P>0.05);the postoperative drainage volume of the intravenous group,the local group and the combined group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05);The total bleeding in the combined group,the local group and the intravenous group was lower than the control group,the difference was statistically significant(P< 0.05),and the combined group was the least;3.There was no significant difference in Hb and Hct between the four groups of patients before operation(P>0.05).There were significant differences between the combined group and the intravenous group,local group,and control group on the first day after surgery(P<0.05),the intravenous group Compared with the local group and the control group,the difference was statistically significant(P<0.05).The local group and the control group were significantly different(P<0.05);the combined group was significantly different from the local group and the control group on the third day after surgery.There is statistical significance(P<0.05),but there is no significant difference compared with the intravenous group(P > 0.05),the intravenous group has statistical significance compared with the local group and the control group(P<0.05),the local group and the control There was no significant difference between the groups(P>0.05).There were no statistically significant differences in Plt,APTT,PT,TT,FIB,FDP and D-D among and within groups(P>0.05);4.All patients had double-dose before operation and 1 day before discharge There was no deep vein thrombosis in the results of ultra-examination of the lower extremity veins;there was no significant difference in postoperative complications between the four groups of patients(P>0.05).Conclusion:1.The three application methods of tranexamic acid in modified transforaminal lumbar interbody fusion are safe and effective,and will not increase the incidence of venous thromboembolism(VTE)and other complications;2.The combined application of tranexamic acid has better hemostatic effect than intravenous or local use alone;3.The topical application of tranexamic acid can significantly reduce postoperative drainage. |
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