氨甲环酸局部应用对跟骨骨折内固定改良L形切口术后愈合的影响
Effect of local application of tranexamic acid on healing of L-shaped incision for internal fixation of calcaneal fractures
蔡沛彪 1罗瑞琴 1郑志辉 1李晓武 1陈海波 1曾庆强1
作者信息
- 1. 汕头市中医医院骨二科,广东 515041
- 折叠
摘要
目的 观察氨甲环酸局部应用对跟骨骨折内固定改良L形切口术后愈合的影响及安全性分析.方法 回顾性分析自2021-10-2023-02行改良L形切口锁定钢板内固定治疗的60例跟骨骨折,按随机数字表法分为观察组30例和对照组30例,对照组松止血带前30 min静脉滴注氨甲环酸(20 mg/kg,溶于100 mL生理盐水),观察组在此基础上联合闭创前局部浸润氨甲环酸(1g,溶于20mL生理盐水)3～5 min.比较两组手术时间、术后引流量、切口干燥时间、切口愈合时间、凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原以及并发症发生情况.结果 60例均顺利完成手术,随访时间14～21 d,平均15.7d.两组手术时间差异无统计学意义(P＞0.05).观察组术后引流量、切口干燥时间、切口愈合时间均优于对照组,差异有统计学意义(P＜0.05).两组术前及术后第1天凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原组间比较,差异均无统计学意义(P＞0.05).两组术后3d、术后14 d复查未发现下肢深静脉血栓形成、肺栓塞.观察组术后皮缘坏死1例,皮下血肿1例;对照组皮缘坏死2例,浅表感染1例,皮下血肿4例.结论 联合局部应用氨甲环酸可促进跟骨骨折内固定改良L形切口愈合,减少术后引流量,降低并发症发生率,且不会对患者凝血功能造成影响,安全性、可行性较高,值得临床推广应用.
Abstract
Objective To observe the effect of tranexamic acid local application on the healing of calcaneal fractures after im-proved L-shaped incision operation and analyze its safety.Methods Sixty cases of calcaneal fractures treated with improved L-shaped incision locking plate from October 2021 to February 2023 were retrospectively analyzed.They were randomly divid-ed into observation group(30 cases)and control group(30 cases).The control group was given tranexamic acid(20 mg/kg,dis-solved in 100 mL physiological saline)intravenously 30 minutes before tourniquet loosening,while the observation group was combined with local infiltration of tranexamic acid(1 g,dissolved in 20 mL physiological saline)3-5 min before wound closure.The operation time,postoperative drainage,incision drying time,incision healing time,prothrombin time,activated partial thromboplastin time,fibrinogen and complications were compared between the two groups.Results All 60 cases were success-fully operated,and the follow-up time was 14-21 days,with an average of 15.7 days.There was no significant difference in oper-ation time between the two groups(P＞0.05).The postoperative drainage,incision drying time and incision healing time in the ob-servation group were better than those in the control group,and the difference was statistically significant(P＜0.05).There was no significant difference in prothrombin time,activated partial thromboplastin time and fibrinogen between the two groups be-fore operation and on the first day after operation(P＞0.05).No deep venous thrombosis and pulmonary embolism were found in the two groups at 3 days and 14 days after operation.In the observation group,there was 1 case of skin edge necrosis and 1 case of subcutaneous hematoma after operation.In the control group,there were 2 cases of skin edge necrosis,1 case of superficial in-fection and 4 cases of subcutaneous hematoma.Conclusion The local application of tranexamic acid can promote the healing of L-shaped incision for internal fixation of calcaneal fractures,reduce the postoperative drainage,reduce the incidence of com-plications,and will not affect the coagulation function of patients.It is safe and feasible,and is worthy of clinical application.
关键词
跟骨骨折/氨甲环酸/局部浸润/术后引流量/切口干燥时间/切口愈合时间Key words
Calcaneal fracture/Tranexamic acid/Local infiltration/Postoperative drainage/Incision drying time/Incision heal-ing time引用本文复制引用
基金项目
汕头市医疗卫生科技计划(第三批)(210909176492023)
出版年
2024
NETL
NSTL
万方数据