髓腔內注射氨甲環酸對股骨粗隆間骨折帶鎖髓內釘治療隱性失血的影響

白楊平　羅偉初　林秦毅　戴高偉　曾文釗　劉琳

【摘要】 目的：探討髓腔注射氨甲環酸對股骨粗隆間骨折帶鎖髓內釘隱性失血的影響。方法：隨機選取筆者所在醫院2018年8月-2020年2月收治的股骨粗隆間骨折患者61例，按照隨機數表法進行分組，所有患者實施股骨粗隆間骨折透視下閉合復位帶鎖髓內釘內固定治療，其中對照組32例股骨髓腔內不做任何處理;觀察組29例實施股骨髓腔內注射氨甲環酸3 g治療，對比兩組輸血率與隱性失血量。結果：觀察組輸血率明顯低于對照組，組間比較差異有統計學意義（P<0.05）;觀察組隱性失血量明顯低于對照組，組間比較差異有統計學意義（P<0.05）。結論：認為股骨粗隆間骨折患者行透視下閉合復位帶鎖髓內釘內固定治療過程中，在股骨近端擴髓后股骨髓腔內注射氨甲環酸3 g治療，能夠有效減少患者術后隱性失血量，降低術后輸血率，值得在臨床應用中推廣。

【關鍵詞】 髓腔 股骨粗隆間骨折 氨甲環酸 注射 隱性失血 輸血率

doi：10.14033/j.cnki.cfmr.2020.16.055 文獻標識碼 B 文章編號 1674-6805（2020）16-0-03

Effect of Intramedullary Tranexamic Acid Injection on the Treatment of Inapparent Blood Loss in Intertrochanteric Fractures with Interlocking Intramedullary Nailing/BAI Yangping， LUO Weichu， LIN Qinyi， DAI Gaowei， ZENG Wenzhao， LIU Lin. //Chinese and Foreign Medical Research， 2020， 18（16）： -137

[Abstract] Objective： To investigate the effect of intramedullary Tranexamic Acid injection on occult blood loss in intertrochanteric fracture of femur with interlocking intramedullary nail. Method： Sixty-one patients with intertrochanteric fractures admitted to our hospital from August 2018 to February 2020 were randomly selected and grouped according to the method of random number table. All patients were treated with closed reduction and locked intramedullary nail internal fixation under fluoroscopy for intertrochanteric fractures， in which 32 patients in the control group were not treated with femoral bone marrow lumen. In the observation group， 29 patients were treated with intramedullary injection of Tranexamic Acid 3 g in femoral bone marrow. And the blood transfusion rate and the latent blood loss were compared between the two groups. Result： The transfusion rate of the observation group was significantly lower than that of the control group， and the difference was statistically significant （P<0.05）. The amount of latent blood loss in the observation group was significantly less than that in the control group， and the difference between the groups was statistically significant （P<0.05）. Conclusion： It is believed that in the treatment of intertrochanteric fracture patients with fluoroscopic closed reduction with locking intramedullary nail internal fixation， the injection of Tranexamic Acid 3 g into the femoral bone marrow cavity after proximal femoral reaming can effectively reduce the patients postoperative blood loss and reduce the postoperative blood transfusion rate， which is worth promoting in clinical application.

[Key words] Medullary cavity Intertrochanteric fracture of femur Tranexamic Acid Injection Recessive blood loss Blood transfusion rate

First-authors address： Qingyuan Qingxin District Peoples Hospital， Qingyuan 511800， China

股骨粗隆間骨折在臨床上非常常見，以老年患者為主，其中女性多見，常因輕微外傷跌倒所致。老年患者多合并多重內科疾病，手術進行牢固的固定，可以使患者早期活動，減少臥床并發癥，降低病死率，改善生活質量[1]。股骨近端防旋髓內釘（proximal femoral nail antirotation，PFNA）因具有切口小、閉合復位、骨折固定堅固、手術時間短、并發癥少、術后恢復快等優點，當前已成為老年股骨轉子間骨折首選的手術方式[2]。但使用股骨近端防旋髓內釘固定股骨粗隆間骨折術后發生隱性失血量大的情況非常普遍，貧血嚴重影響術后老年患者整體康復。面對目前血源緊張的情況，為減少輸血，讓老年患者盡快康復。故很多骨科醫生都在研究如何減少因使用股骨近端防旋髓內釘固定股骨粗隆間骨折術后發生隱性失血的問題[3]。……