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Randomized Controlled Trial
. 2020 Apr 15;34(4):463-468.
doi: 10.7507/1002-1892.201908138.

[Application of intravenous injection of tranexamic acid combined with local use of tranexamic acid cocktail in intertrochanteric fracture fixation]

[Article in Chinese]
Qingyan Zhang  1 , Chao Xiang  1 , Xiaoting Chen  1 , Lin Chen  1 , Qian Chen  1 , Ke Jiang  1 , Lu Chen  1 , Yuling Li  1 , Peng Wei  1
Affiliations
Randomized Controlled Trial

[Application of intravenous injection of tranexamic acid combined with local use of tranexamic acid cocktail in intertrochanteric fracture fixation]

[Article in Chinese]
Qingyan Zhang et al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. .

Abstract
in English, Chinese

Objective: To explore the efficacy and safety of intravenous injection of tranexamic acid (TXA) combined with local use of TXA cocktail in intertrochanteric fracture fixation with proximal femoral nail antirotation (PFNA).

Methods: Patients with intertrochanteric fractures who underwent close reduction and internal fixation with PFNA between February 2018 and March 2019 were enrolled in the study. Among them, 45 patients who met the selection criteria were included in the study and randomly allocated into 3 groups ( n=15). The patients in group A were not received TXA during perioperative period. The patients were intravenously injected of 1.0 g TXA before operation in group B and combined with local use of TXA cocktail during operation in group C. There was no significant difference in the age, gender, body mass index, fracture classification, disease duration, and complications between groups ( P>0.05). The perioperative blood loss and blood transfusion rate, the visual analogue scale (VAS) score before operation and at 12, 24, and 48 hours after operation, the levels of prostaglandin E2 (PGE2) and bradykinin (BK) before operation and at 1 and 3 days after operation, postoperative complications, and the maximum amplitude (MA) of thromboelastogram were recorded and compared between groups.

Results: The total blood loss, hidden blood loss, and visible blood loss were significantly lower in groups B and C than those in group A ( P<0.05), and the total blood loss and hidden blood loss were significantly lower in group C than those in group B ( P<0.05). There was no significant difference in the blood transfusion rate, preoperative VAS scores and the levels of PGE2 and BK between groups ( P>0.05). The postoperative VAS scores and the levels of PGE2 and BK were significantly lower in group C than in groups A and B ( P<0.05). There was no significant difference in pre- and post-operative MA of thromboelastogram between groups ( P>0.05). The incidences of postoperative complications were 33.33% (5/15), 20.00% (3/15), and 13.33% (2/15) in groups A, B, and C, respectively, with no significant difference between groups ( χ 2=1.721, P=0.550).

Conclusion: For intertrochanteric fractures, application of intravenous injection of TXA combined with local use of TXA cocktail in PFNA fixation can reduce perioperative blood loss, relieve pain after operation, and do not increase the risk of complications.

目的: 探讨在股骨转子间骨折闭合复位股骨近端防旋髓内钉（proximal femoral nail antirotation，PFNA）内固定术中，静脉滴注氨甲环酸（tranexamic acid，TXA）联合局部注射“TXA 鸡尾酒”减少围术期失血及缓解早期疼痛的安全性及有效性。.

方法: 以 2018 年 2 月—2019 年 3 月拟行闭合复位 PFNA 内固定的股骨转子间骨折患者作为研究对象，其中 45 例患者符合选择标准纳入研究。采用随机数字表法将患者随机分为 3 组（ n=15），空白对照组（A 组）不使用 TXA，静脉应用组（B 组）仅术前静脉滴注 1.0 g TXA，静脉联合局部应用组（C 组）术前静脉滴注 1.0 g TXA 联合术中局部应用“TXA 鸡尾酒”。3 组患者性别、年龄、体质量指数、骨折 AO 分型、病程、合并内科疾病比较，差异均无统计学意义（ P>0.05）。比较 3 组患者围术期失血量及输血情况，术前及术后 12、24、48 h 疼痛视觉模拟评分（VAS），术前及术后 1、3 d ELISA 法检测炎症因子前列腺素 E2（prostaglandin E2，PGE2）与缓激肽（bradykinin，BK）表达水平，术后并发症发生情况，以及术前及术后 3、7 d 血栓弹力图最大振幅值。.

结果: B、C 组总失血量、隐性失血量、显性失血量均明显少于 A 组（ P<0.05），C 组总失血量、隐性失血量明显少于 B组（ P<0.05）。3 组输血率差异无统计学意义（ P>0.05）。3 组患者术前 VAS 评分及 PGE2、BK 表达水平比较，差异均无统计学意义（ P>0.05）；术后各时间点 C 组 PGE2、BK 表达水平及 VAS 评分均明显低于 A、B 组（ P<0.05）。血栓弹力图显示 3 组术前及术后 3、7 d最大振幅值差异均无统计学意义（ P>0.05）。术后 A 组 5 例（33.33%）、B 组 3 例（20.00%）、C 组 2 例（13.33%）发生并发症，3 组并发症发生率比较差异无统计学意义（ χ 2=1.721， P=0.550）。.

结论: 股骨转子间骨折闭合复位 PFNA 内固定术中，通过静脉滴注 TXA 联合局部注射“TXA 鸡尾酒”可以明显减少围术期失血量、减轻患者术后疼痛，而且不增加并发症发生风险。.

Keywords: Intertrochanteric fracture; blood loss; cocktail therapy; internal fixation; perioperative period; tranexamic acid.

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Conflict of interest statement

利益冲突：所有作者声明，在课题研究和文章撰写过程中不存在利益冲突。基金项目经费支持没有影响文章观点和对研究数据客观结果的统计分析及其报道。

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