Intraoperative local application of thrombin and postoperative blood loss in intramedullary fixation of femoral intertrochanteric fracture
10.3760/cma.j.cn115530-20240229-00096
- VernacularTitle:老年股骨转子间骨折髓内固定术中局部应用凝血酶对术后失血量的影响研究
- Author:
Songxia HE
1
;
Wei SU
;
Peng WEI
Author Information
1. 宁波大学附属第一医院整形修复重建外科，宁波 315010
- Keywords:
Hip fractures;
Fracture fixation, intramedullary;
Bone nails;
Postoperative hemorrhage;
Proximal femoral nail antirotation
- From:
Chinese Journal of Orthopaedic Trauma
2024;26(6):493-498
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the effect of intraoperative local application of thrombin on postoperative blood loss in internal fixation of femoral intertrochanteric fracture with proximal femoral nail antirotation (PFNA).Methods:A retrospective study was conducted to analyze the 50 patients with intertrochanteric femur fracture who had been treated at Department of Orthopaedics, The First Ningbo Hospital & Longshan Hospital Medical Health Group between January 2021 and December 2023. The patients were divided into 2 groups according to whether local thrombin was applied intraoperatively or not. In the treatment group of 25 cases [9 males and 16 females aged (76.5±10.1) years], after PFNA implantation, 6 pieces of thrombin freeze-dried powder were dissolved in 60 mL of sterile physiological saline, 30 mL of which was sprayed inside the main nail incision, 20 mL of which inside the spiral blade incision, and 10 mL of which inside the distal locking nail incision. In the control group of 25 cases [11 males and 14 females aged (71.1±10.1) years], after PFNA implantation, the incisions were rinsed only with the same doses of physiological saline. The hemoglobin (Hb) and hematocrit (Hct) on the 1st, 3rd, and 7th days after surgery, total blood loss, occult blood loss, transfusion rate, and deep vein thrombosis (DVT) were compared between the 2 groups.Results:There were no significant differences in the preoperative general data or operation time between the 2 groups, indicating comparability ( P>0.05). On the 1st, 3rd, and 7th days after surgery, respectively, the Hb was (101.48±12.15) g/L, (102.96±12.76) g/L, and (107.24±13.47) g/L, and the Hct 0.31±0.03, 0.32±0.03, and 0.33±0.04 in the treatment group, significantly higher than those in the control group [(92.72±10.95) g/L, (86.52±7.43) g/L, and (91.56±10.24) g/L; 0.28±0.03, 0.26±0.03, and 0.27±0.03] ( P<0.05). In the treatment group, the total postoperative blood loss was (364.60±134.27) mL, and the occult blood loss was (258.04±112.59) mL, both significantly lower than those in the control group [(481.72±218.69) mL and (355.84±176.97) mL] ( P<0.05). In the treatment group and the control group, respectively, 2 patients and 1 patient developed DVT after surgery, showing no statistically significant difference in the incidence ( P>0.05). Conclusion:Intraoperative local application of thrombin can significantly reduce postoperative blood loss but may not increase postoperative thrombosis or other complications in PFNA internal fixation of femoral intertrochanteric fracture.
