白杨平　罗伟初　林秦毅　戴高伟　曾文钊　刘琳

【摘要】 目的：探讨髓腔注射氨甲环酸对股骨粗隆间骨折带锁髓内钉隐性失血的影响。方法：随机选取笔者所在医院2018年8月-2020年2月收治的股骨粗隆间骨折患者61例，按照随机数表法进行分组，所有患者实施股骨粗隆间骨折透视下闭合复位带锁髓内钉内固定治疗，其中对照组32例股骨髓腔内不做任何处理;观察组29例实施股骨髓腔内注射氨甲环酸3 g治疗，对比两组输血率与隐性失血量。结果：观察组输血率明显低于对照组，组间比较差异有统计学意义（P<0.05）;观察组隐性失血量明显低于对照组，组间比较差异有统计学意义（P<0.05）。结论：认为股骨粗隆间骨折患者行透视下闭合复位带锁髓内钉内固定治疗过程中，在股骨近端扩髓后股骨髓腔内注射氨甲环酸3 g治疗，能够有效减少患者术后隱性失血量，降低术后输血率，值得在临床应用中推广。

【关键词】 髓腔 股骨粗隆间骨折 氨甲环酸 注射 隐性失血 输血率

doi：10.14033/j.cnki.cfmr.2020.16.055 文献标识码 B 文章编号 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

股骨粗隆间骨折在临床上非常常见，以老年患者为主，其中女性多见，常因轻微外伤跌倒所致。老年患者多合并多重内科疾病，手术进行牢固的固定，可以使患者早期活动，减少卧床并发症，降低病死率，改善生活质量[1]。股骨近端防旋髓内钉（proximal femoral nail antirotation，PFNA）因具有切口小、闭合复位、骨折固定坚固、手术时间短、并发症少、术后恢复快等优点，当前已成为老年股骨转子间骨折首选的手术方式[2]。但使用股骨近端防旋髓内钉固定股骨粗隆间骨折术后发生隐性失血量大的情况非常普遍，贫血严重影响术后老年患者整体康复。面对目前血源紧张的情况，为减少輸血，让老年患者尽快康复。故很多骨科医生都在研究如何减少因使用股骨近端防旋髓内钉固定股骨粗隆间骨折术后发生隐性失血的问题[3]。……