【摘要】 目的观察不同氨甲环酸应用方法对老年股骨颈骨折股骨头置换术后引流量的影响。方法前瞻性收集中南大学湘雅医学院附属海口医院骨科中心收治的75例行股骨头置换术的股骨颈骨折患者,随机分为A组、B组、C组,三组各25例。A组关闭切口前静脉滴注1%氨甲环酸1 g+关节周围软组织局部注射5%氨甲环酸20 ml+缝合伤口后经引流管推注5%氨甲环酸20 ml浸泡2 h,B组关闭切口前静脉滴注生理盐水100 ml+关节周围软组织局部注射5%氨甲环酸20 ml+缝合伤口后经引流管推注5%氨甲环酸20 ml浸泡2 h,C组关闭切口前静脉滴注生理盐水100 ml+关节周围软组织局部注射生理盐水20 ml+缝合伤口后经引流管推注生理盐水20 ml浸泡2 h。观察术后24 h三组患者伤口引流量,术后48 h血红蛋白变化值。结果 A组术后24 h引流量[(47±10)ml]、48 h血红蛋白变化值[(10±4)g/L]均低于B组[(110±25)ml、(16±5)g/L]及C组[(131±22)ml、(18±6)g/L],差异均有统计学意义(P<0.05)。B组术后24 h引流量低于C组,差异有统计学意义(q=5.241,P<0.05),B组术后48 h血红蛋白变化值与C组比较,差异无统计学意义。结论老年股骨颈骨折患者行人工股骨头置换术关闭切口时静脉滴注1%氨甲环酸1 g+关节周围软组织局部注射5%氨甲环酸20 ml+缝合伤口后经引流管注射5%氨甲环酸20 ml浸泡2 h可以明显减少术后引流量及血红蛋白变化值。人工股骨头置换术中关节周围软组织局部注射氨甲环酸+缝合伤口后经引流管推注氨甲环酸浸泡2 h可减少术后引流量,对血红蛋白变化值无影响。更多还原

【Abstract】 Objective To observe the effect of tranexamic acid in different application methods on the amount of drainage after femoral head replacement in elderly femoral neck fractures. Methods A prospective study was performed in 75 cases of femoral neck fractures who had underwent femoral head replacement in Xiangya Medical College of Central South University, Department of orthopedics center of Haikou Hospital. Patients were randomly divided into group A, group B and group C, 25 cases in each group. Group A gave 1 g 1% tranexamicacid though intravenous drip infusion before closing the incision + local injection of 20 ml 5% tranexamic acid into periarticular soft tissue before closing the incision + a bolus of 20 ml 5% tranexamic acid through drainage tube after suturing the wound and soaking 2 hours. Patients in group B gave intravenous drip infusion of 100 ml normal saline before closing the incision and local injection of 20 ml 5% tranexamic acid into periarticular soft tissue before closing the incision +a bolus of 20 ml 5% tranexamic acid through drainage tube after suturing the wound and soaking two hours. In group C intravenous drip infusion of 100 ml normal saline was given before closing the incision and local injection of 20 ml normal saline to periarticular soft tissue before closing the incision + a bolus of 20 ml normal saline through drainage tube after suturing the wound and soaking 2 hours. The wound drainage of three groups at 24 hours after operation and the hemoglobin changes after 48 hours were evaluated. Results Twenty-four hours postoperative drainage, hemoglobin variation in 48 hours after operation of group A [(47 ± 10)ml,(10 ± 4)g/L] was significantly lower than group B [(110±25)ml,(16±5)g/L] and group C[(131±22)ml,(18±6)g/L], the differences were statistically significant(P<0.05). 24 hours postoperative drainage of group B was lower than that of group C, difference was statistically significant(q=5.241, P<0.05). Hemoglobin variation in 48 hours after operation of group B was not significantly reduced compared with group C(q=0.721, P>0.05). Conclusions The intravenous drip of 1 g 1% tranexamic acid and local injection of 20 ml 5% tranexamic acid in periarticular soft tissue + local injection of 20 ml 5% tranexamic acid into periarticular soft tissue before closing the incision + a bolus of 20 ml 5% tranexamic acid through drainage tube after suturing the wound and soaking 2 hours can significantly reduce drainage and hemoglobin change value in elderly femoral neck fracture patients with artificial femoral head replacement. Local injection of tranexamic acid in periarticular soft tissue during artificial femoral head replacement and injection of tranexamic acid though drainage tube after suturing the wound and soaking for 2 hours can reduce the postoperative drainage, but have no effect on the hemoglobin change.更多还原