The role of preoperative intravenous administration of tranexamic acid in the treatment of proximal humeral fractures in elderly patients with locked steel plate internal fixation
Objective To explore and analyze the efficacy of preoperative intravenous tranexamic acid(TXA)in reducing bleeding and alleviating early postoperative pain in elderly patients with proximal humeral fractures(PHF)who underwent minimally invasive plate osteosynthesis(MIPO)approach with open reduction and locking plate internal fixation.Methods A retrospective analysis was conducted on the data of 165 elderly patients with partial or partial PHF who underwent open reduction and locking plate internal fixation via MIPO approach at the Yixing People's Hospital from June 2018 to June 2021.According to whether TXA was used intravenously 30 minutes before surgery,patients were divided into a TXA group(77 cases)and a control group(88 cases).The surgical time,hemoglobin decrease,total blood loss(TBL),intraoperative blood loss(IBL),postoperative drainage volume,visible blood loss(VBL),hidden blood loss(HBL),blood transfusion status,Visual Analogue Scale(VAS)score for surgical site pain 24 hours after surgery,postoperative hospital stay,shoulder Constant-Murley function score at 1 and 3 months after surgery,and complications were recorded and compared between the two groups.Results The TBL,VBL,IBL,HBL,postoperative drainage volume,hemoglobin decrease,transfusion rate,postoperative VAS score at the surgical site,and hospital stay in the TXA group were all lower than those in the control group,and the differences were statistically significant(all P＜0.05).The VAS score at the surgical site 24 hours after surgery was positively correlated with TBL and HBL in two groups of patients(r=0.402,0.418,P＜0.001).Compared with the control group,the TXA group had a higher shoulder Constant-Murley function score at 1 month after surgery,and the difference was statistically significant(P=0.002).There was no statistically significant difference in shoulder Constant-Murley function score and incidence of complications between the two groups at 3 months after surgery(all P＞0.05).Conclusions For elderly patients with partial or partial PHF who underwent open reduction and locking plate internal fixation using MIPO approach,intravenous infusion of TXA 30 minutes before surgery can help alleviate postoperative pain at the surgical site,reduce intraoperative and postoperative bleeding,lower transfusion rates,shorten hospital stay,and do not increase the incidence of complications such as incision abnormalities and thrombosis,which is beneficial for promoting early and rapid recovery of patients.
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