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BACKGROUND: The perioperative blood loss of total knee arthroplasty is large. The “cocktail” containing tranexamic acid has the dual function of hemostasis and analgesia. However, how to further reduce blood loss with intravenous tranexamic acid is still worth exploring. OBJECTIVE: To compare the hemostatic effect and safety of tranexamic acid combined with different intravenous applications of tranexamic acid in total knee arthroplasty under the premise of using “cocktail” containing tranexamic acid. METHODS: Data of 62 patients with osteoarthritis, who underwent primary unilateral total knee arthroplasty in the First Department of Orthopedics of Zhongshan People’s Hospital from June 2017 to September 2019, were retrospectively analyzed and divided into three groups. In the Group A, 26 patients administrated “cocktail” containing tranexamic acid before closing the wound. In the Group B, 25 patients administrated intravenously 1.0 g tranexamic acid before cutting skin on the basis of group A. In the Group C, 11 patients administrated intravenously 1.0 g tranexamic acid on the basis of group B 3 hours postoperatively. Dominant, hidden, and total blood loss, postoperative hemoglobin biggest loss, blood transfusion rate, postoperative hospital stay and postoperative complications were compared and analyzed among three groups. RESULTS AND CONCLUSION: (1) In terms of blood loss (including total, hidden, intraoperative, postoperative and dominant) and the maximum loss of hemoglobin, both groups B and C were lower than group A, with statistically significant differences (P 0.05). (2) There were no statistically significant differences in blood transfusion rate and postoperative hospital stay among three groups (P > 0.05). (3) There were no statistically significant differences among the three groups in the incidence of wound complications, articular effusion, and complications of intermuscular vein thrombosis (P > 0.05). No lower limb deep vein thrombosis or pulmonary embolism was found in the three groups. (4) The results showed that intravenous administration of 1.0 g tranexamic acid before cutting skin and combination with “cocktail” containing 0.5 g tranexamic acid before closing the wound can have obvious hemostatic effect. However, intravenous administration of 1.0 g tranexamic acid 3 hours postoperatively failed to further reduce the bleeding; moreover, the first two administrations did not increase the postoperative complications, and had certain security.
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BACKGROUND: In the elderly patients with intertrochanteric fractures, a large amount of hidden bleeding appears after surgery, so reducing hidden bleeding has become an important problem to be solved urgently. OBJECTIVE: To evaluate the effect of preoperative intravenous injection of tranexamic acid on the hidden blood loss after proximal femoral nail antirotation implantation. METHODS: Eighty-two cases of senile intertrochanteric fractures at Department of Traumatic Orthopedics of Guang’an People’s Hospital from July 2018 to July 2019 were selected, and all the patients underwent internal fixation with proximal femoral nail antirotation. The patients were allocated into two groups based on usage of tranexamic acid (n=41/group). In trial group, intravenous injection of tranexamic acid (10 mg/kg) was conducted during anesthesia, and control group was given the same volume of normal saline via vein. Blood routine examination was conducted at baseline and 1, 3 and 5 days postoperatively to count the level of hemoglobin and hematocrit. The total blood loss was calculated by Gross equation. The transfusion rate and postoperative incidence of thrombosis were recorded. RESULTS AND CONCLUSION: (1) There was no significant difference in the dominant blood loss between two groups (P > 0.05). (2) The perioperative actual total blood loss and postoperative hidden blood loss in the trial group were significantly lower than those in the control group (P < 0.05). (3) Three cases of blood transfusion (7%) in the trial group, and eight cases (24%) in the control group (P < 0.05). (4) No thrombosis occurred in both groups. (5) These findings suggest that preoperative intravenous infusion of tranexamic acid can effectively reduce the hidden blood loss after proximal femoral nail antirotation implantation, and does not increase the risk of postoperative thrombosis.
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OBJECTIVE@#To investigate the influencing factors of hidden blood loss (HBL) during the treatment of percutaneous vertebroplasty (PVP).@*METHODS@#The clinical data of 125 patients with osteoporotic vertebral compression fractures (OVCFs) treated with percutaneous vertebroplasty from March 2016 to December 2017 were retrospectively analyzed. All patients underwent X rays of the AP and lateral lumbar spine, double oblique, and dynamic positions. Lumbar spine CT, MRI, and dual energy X ray bone densitometer (DXA) were used to confirm the diagnosis. There were 55 males and 70 females, 10 cases of thoracic vertebrae, 89 cases of thoracolumbar vertebrae, 26 cases of lumbar vertebrae, 87 cases with single segment, 29 cases with double segment,and 9 cases with 3 segments. The vertebral compression height ratios of 67 patients were less than 1 / 3, and the ratios for 41 patients were from 1 / 3 to 2 / 3,for 17 patients were more than 2 / 3. Blood routine examination were performed before and 3 days after surgery to analyze hidden blood loss and to explore its risk factors.@*RESULTS@#The average hidden blood loss was (317±156) ml in 125 patients. Multiple linear regression analysis revealed a history of diabetes(=0.011),surgical segments(=0.036),number of segments (<0.001),vertebral height loss rate (=0.002),vertebral height recovery rate (<0.001) and bone cement leakage rate (=0.003) were positively correlated with hidden blood loss. Moreover,it was found that the blood loss was higher in those with higher vertebral height loss rate than in those with lower vertebral height loss rate, and the blood loss was higher in those with good vertebral height recovery than those with poor vertebral height recovery. Additionally,the cement leakage was also an important factor in increasing hidden blood loss. However,there was no significant correlation between bone mineral density(=0.814) or history of hypertension(=0.055) and hidden blood loss.@*CONCLUSION@#Patients with OVCFs have a large amount of hidden blood loss after PVP treatment, which needs attention. At the same time, the history of diabetes, surgical segments, number of segments, bone cement leakage rate, vertebral height loss rate and vertebral height recovery rate are the risk factors for hidden blood loss.
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Female , Humans , Male , Bone Cements , Fractures, Compression , Osteoporotic Fractures , Retrospective Studies , Risk Factors , Spinal Fractures , Treatment Outcome , VertebroplastyABSTRACT
Intertrochanteric fracture of femur (IFF) is a common fracture type in traumatic orthopedics,which seriously affects patients' quality of life and health.Studies have shown that the fibrinolytic system can be activated in the invasive operation of IFF,which leads to massive blood loss during and after operation,especially hidden blood loss.Tranexamic acid,as an anti-fibrinolytic drug,can effectively reduce fibrinolytic activity by inhibiting fibrinolysis induced by fibrinolytic enzymes in order to stop bleeding.In recent years,with the diversified development of surgical hemostasis methods and the continuous exploration of hemostatic drugs,the application of anti-fibrinolytic drugs represented by tranexamic acid in perioperative period of IFF has gradually increased.Based on literatures at home and abroad,this paper aims to summarize the research progress of the application of tranexamic acid to reduce the perioperative hidden blood loss in intertrochanteric fracture,providing reference for clinical treatment decision.
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OBJECTIVE@#To investigate the hidden blood loss and related risk factors of osteoporotic vertebral compression fractures after percutaneous kyphoplasty.@*METHODS@#The clinical data of 153 patients with osteoporotic vertebral compression fractures who underwent percutaneous kyphoplasty from March 2015 to December 2017 were retrospectively analyzed, including 55 males and 98 females, aged 68 to 87(78.6±11.4) years old. Erythrocyte specific volume was collected before and after operation to calculate the hidden blood loss. The influence of sex, age, body mass index, bone mineral density, diabetes mellitus and hypertension, operation mode (unilateral or bilateral), operation time, operative segment and number, loss height of vertebral body and recovery height ratio on hidden blood loss was analyzed by multiple linear regression model.@*RESULTS@#Postoperative hidden blood loss was (287.7±68.5) ml. Multivariate linear regression analysis showed that the history of diabetes mellitus (β=2.405, =0.012), the mode of operation(β=3.042, <0.001), the time of operation (β=2.043, =0.038), the operative segment (β=1.993, =0.043), the number (β=0.374, <0.001), the loss of vertebral height (β=2.785, =0.003) and the recovery ratio(β=7.301, <0.001) were correlated with occult hemorrhage.@*CONCLUSIONS@#There is a certain degree of occult hemorrhage in kyphoplasty for osteoporotic vertebral compression fractures. The risk factors of hidden hemorrhage are diabetes history, operation method, operation time, operative segment and number, loss of vertebral height and recovery ratio.
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Aged , Aged, 80 and over , Female , Humans , Male , Fractures, Compression , Kyphoplasty , Osteoporotic Fractures , Retrospective Studies , Spinal Fractures , Treatment OutcomeABSTRACT
Objective: To evaluate the effect of pneumatic tourniquet on perioperative period of total knee arthroplasty (TKA). Methods: The perioperative period data of 116 patients over 60 years old with severe knee osteoarthritis treated with TKA between January 2018 and January 2019 were retrospectively analyzed. According to whether pneumatic tourniquet was used during operation, the patients were divided into trial group (49 cases, pneumatic tourniquet was not used during operation) and control group (67 cases, pneumatic tourniquet was used during operation). There was no significant difference in gender, age, body mass index, lesion side, disease duration, and preoperative hemoglobin between the two groups ( P>0.05). The operation time, actual total blood loss, overt blood loss, hidden blood loss, and percentage of hidden blood loss, knee swelling at 3 days after operation, and range of motion of knee at 2 weeks after operation were recorded and compared between the two groups. Results: The operation time of the trial group was significantly longer than that of the control group ( t=14.013, P=0.000). The actual total blood loss, hidden blood loss, and percentage of hidden blood loss in the trial group were significantly lower than those in the control group ( P<0.05); there was no significant difference in the overt blood loss between the two groups ( t=-1.293, P=0.200). The knee swelling degree in the trial group was significantly slighter than that in the control group at 3 days after operation, and the range of motion of knee in the trial group was significantly better than that in the control group at 2 weeks after operation ( P<0.05). Conclusion: Pneumatic tourniquet can reduce the operation time of TKA significantly. However, it may increase the hidden blood loss and knee swelling, and negatively impact the recovery of knee function in the early postoperative stage of TKA.
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Objective: To analyze the effectiveness of fast track protocol of geriatric intertrochanteric fracture on operative waiting time, operation time, perioperative blood loss, providing data support for clinical therapy. Methods: The clinical data of 240 elderly patients with intertrochanteric fracture admitted between January 2015 and December 2018 were retrospectively analyzed. They were divided into traditional protocol group (148 cases, group A) and fast track group (92 cases, group B). All patients were treated with closed reduction intramedullary nail (proximal femoral nail antirotation) surgery. There was no significant difference in gender, age, sides, fracture classification, fracture type, complications, the proportion of patients with more than 3 kinds of medical diseases, and the time from injury to admission between the two groups ( P>0.05). Analysis index included operative waiting time (hospitalization to operation time), operation time, percentage of operation performing in 48 and 72 hours, percentage of transfusion, changes of hematocrit (Hct) at different stage (admission, operation day, and postoperative 1, 3 days), blood loss by fracture and cephalomedullary nail, intraoperative dominant blood loss, total blood loss in perioperative period were recorded and compared. Results: The operative waiting time, operation time, Hct on operation day and postoperative 3 days, blood loss by fracture, transfusion volume, and total blood loss in perioperative period in group B were significantly less than those in group A ( P0.05). Conclusion: Fast track can shorten the operative waiting time of geriatric intertrochanteric fracture, reduce the blood loss by fracture, total blood loss in perioperative period, and transfusion volume. Early operation is conducive to improve the anemia status of patients during perioperative period.
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Objective To compare minimally invasive percutaneous pedicle screw fixation and open pedicle screw fixation for neurologically intact thoracolumbar fractures.Methods A retrospective study was conducted in the 180 patients who had been treated for thoracolumbar fractures without neurological deficits from January 2016 to December 2016.Of them,93 were treated by minimally invasive percutaneous pedicle screw fixation and 87 by open pedicle screw fixation.The 2 groups were compared in terms of blood loss,radiological parameters,visual analogue scale (VAS) and Oswestry disability index (ODI).Results Compared with the open surgery group,the minimally invasive surgery group had significantly shorter operating time (95.8 ±33.4 min versus 106.3 ±30.9 min),significantly less intraoperative blood loss (65.8 ±40.3 mL versus 183.1 ± 77.5 mL),significantly less total blood loss in theory 24 hours after surgery (374.7 ± 160.6 mL versus 614.8 ± 242.6 mL) and significantly shorter hospital stay (5.2 ± 2.0 d versus 6.7 ± 2.7 d),but significantly longer C-arm exposure time (23.6 ±4.2 min versus 12.4 ±4.1 min) and significantly more hidden blood loss 24 hours after surgery (308.9 ± 159.0 mL versus 243.5 ± 195.5 mL) (P ＜ 0.05).Compared with preoperation,significant improvements were observed at one week postoperation and the last follow-up in the 2 groups regarding the percentage of anterior height of the fractured vertebral body and cobb angle (P ＜ 0.05),but there were no significant differences in the percentage of anterior height of the fractured vertebral body or cobb angle between the 2 groups at one week postoperation or at the last follow-up (P ＞ 0.05).At 3 days postoperation,significant better pain relief was observed in the minimally invasive surgery group than in the open surgery group (P ＜ 0.01),but at the last follow-up no obvious pain was reported in either group.At the last follow-up,there was no significant difference between the 2 groups in ODI (6.2 ± 1.1 versus 6.0 ± 1.4) (P =0.320).Conclusions In the treatment of neurologically intact thoracolumbar fractures,minimally invasive percutaneous pedicle screw fixation may lead to shorter operating time,less blood loss and shorter hospital stay but no poorer radiological outcomes or long-term patient-reported outcomes than the open pedicle screw fixation.However,it should be noted that the former may lead to a higher volume of hidden blood loss.
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Objective To investigate the effect of intravenous tranexamic acid (TXA) on perioperative hidden blood loss in percutaneous pedicle screw fixation for thoracolumbar fractures.Methods A prospective study was conducted in the 113 patients who would be subjected to percutaneous pedicle screw fixation for thoracolumbar fracture from January 2017 to December 2017.They were randomly assigned into an observation group (n =58) receiving intravenous drip of 15 mg/kg TXA 30 minutes preoperation or a control group (n =55) receiving intravenous drip of normal saline solution 30 minutes preoperation.The total blood loss and hidden blood loss 24 hours postoperation,D-dimer volume,incidences of deep vein thrombosis and other complications were recorded and compared between the 2 groups.Results There were 54 patients in the observation group and 50 patients in the control group for statistic analysis.The observation group had significantly less total blood loss (319.0 ± 140.5 mL) and hidden blood loss (242.0 ± 143.4 mL) 24 hours postoperation than the control group (418.7 ± 188.1 mL and 354.7 ± 181.9 mL,respectively) (P ＜ 0.05).There were no significant differences between the 2 groups in operation time or intraoperative blood loss (P ＞ 0.05).The volume of postoperative D-dimer was significantly higher than the preoperative value in both groups (P ＜ 0.05).No thromboembolic events occurred in either group.Conclusion Intravenous TXA may significantly reduce intraoperative hidden blood loss with no increased rik of thromboembolic events in percutaneous pedicle screw fixation for thoracolumbar fractures.
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Objective To explore the risk factors of hidden blood loss after UKA.Methods A retrospec-tive study was conducted on 273 patients who underwent UKA from January 2015 to December 2016,including 79 males and 194 females,age between 46 to 87 years old,mean age(67.21± 8.23)years old. The clinical data were collected and the blood volume was calculated according to the Nadler formula. The Gross equation was used to calculate the blood loss and the amount of occult blood loss at 3 days after operation. The risk factors were analyzed statistically. Results The volume of hidden blood loss after operation was(75.36 ± 10.21)mL,and the volume of total blood lost after operation was(187.35± 60.31)mL.Sex,BMI and type of prosthesis were risk factors for hidden blood loss after UKA. Conclusions The volume of hidden blood loss after UKA was related to sex, BMI,and type of prosthesis. For the obese and male patients,we should actively take bleeding management and choose the type of prosthesis reasonably.
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<p><b>Background</b>Total knee arthroplasty (TKA) is the most frequently performed procedure in treating advanced knee osteoarthritis. Excessive perioperative blood loss can sometimes lead to postoperative anemia. Tranexamic acid (TXA) is a potent fibrinolysis inhibitor which has been extensively used at the surgical incision and closure to lower overall blood loss in adult reconstruction surgery. Our previous study suggested that about two-thirds of the total blood loss (TBL) came from hidden blood loss (HBL) on postoperative days 1 and 2. The role of reducing HBL with TXA administration in postoperative TKA patients is unknown. The current study was designed to evaluate the efficiency and safety of supplemental intravenous (IV) TXA in further reducing HBL after primary TKA.</p><p><b>Methods</b>A prospective pilot study was conducted at a single institution on 43 consecutive patients who underwent unilateral TKA from September 2014 to February 2015. All patients were given 1 g of IV TXA 10-15 min before operation and another 1 g of IV TXA at the time of wound closure on the day of surgery. On postoperative days 1 and 2, the supplemental group (n = 21) was given additional 1 g of TXA intravenously twice a day, whereas the control group (n = 22) received an equal volume of saline. Drain output, hemoglobin (Hb), and hematocrit (HCT) were recorded preoperatively and 5 consecutive days postoperatively in both groups. HBL was calculated with the Gross formula. Pre- and post-operative lower extremity Doppler venous ultrasound was performed in all patients to detect deep vein thrombosis (DVT). The indexes were compared using the Mann-Whitney test, whereas the results of Hb and HCT were analyzed by repeated-measures analysis of variance. The difference was considered statistically significant if P < 0.05.</p><p><b>Results</b>The demographics and surgical characteristics of the two groups were comparable. Supplemental group had higher Hb level on postoperative days 1-5 compared to the control; however, the difference was not significant (F = 2.732, P = 0.106). The HCT of the supplemental group was significantly higher than that of the control group on postoperative day 5 (F = 5.254, P = 0.027). No significant difference was found in drainage volume and TBL, but the HBL was reduced in the supplemental group (supplemental 133.1 [71.8, 287.3] ml and control 296.0 [185.3, 421.4] ml, Z = 2.478, P = 0.013, median [interquartile range]). There was one DVT in the control group and none in the supplemental group. All patients were followed at 1 year after surgery, and no further complications were reported.</p><p><b>Conclusion</b>Based on the current study, additional doses of IV TXA could potentially further reduce HBL after primary TKA without increasing the risk of venous thromboembolism.</p>
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Aged , Female , Humans , Male , Middle Aged , Arthroplasty, Replacement, Knee , Blood Loss, Surgical , Pilot Projects , Prospective Studies , Tranexamic Acid , Therapeutic UsesABSTRACT
Lumbar interbody fusion is one of the most commonly used surgical treatment of lumbar disease at present, but the hidden blood loss after surgery is large, accounting for 1/3 or even more than 1/2 of total blood loss. If not monitored and treated for the hidden blood, it can result in anemia and prolong bed time, thereby increasing the chance of infection. This paper summarizes the mechanism, influencing factors, calculation and treatment of hidden blood loss after lumbar fusion, so that the surgeon can have a correct understanding and evaluation of the hidden blood loss for the patients undergoing lumbar intervertebral fusion, and so as to reduce the occurrence of complications. This is very important for helping patients to pass perioperative period smoothly.
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Humans , Lumbar Vertebrae , Lumbosacral Region , Occult Blood , Perioperative Period , Retrospective Studies , Spinal Fusion , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To compare the clinical efficacy of using tranexamic acid in different ways to reduce the hidden blood loss in patients who receiving total hip arthroplasty (THA).</p><p><b>METHODS</b>Totally 68 patients with osteonecrosis of the femeral head treated by total hip arthroplasty in our hospital from February 2010 to July 2015 were randomly divided into the intravenous drip group (group A) and the topical application group (group B). In group A, there were 19 males and 15 females, with an average age of (62.0±6.4) years old, preoperative average hemoglobin was (121.30±8.15) g/L, average Hematocrit was (0.470±0.039) L/L. In group B, there were 18 males and 16 females, with an average age of (64.0±7.5) years old, preoperative average hemoglobin was (125.28±9.37) g/L, average Hematocrit was (0.490±0.041) L/L. The operation incision were performed through the posterolateral approach and the normal operation mode, biological prosthesis was selected. Through different ways the tranexamic acid was used to control of intraoperative and postoperative bleeding. Tranexamic acid was intra articular injection as a dose of 10 mg/kg 10 min to patient before anesthesia in intravenous drip group. In topic group, 3 g of tranexamic acid was dissolved in 120 ml saline and divided into three equal parts, then two pieces of gauze were immersed in 40 ml tranexamic acid solution. One gauze with 40 ml tranexamic acid was used to soak the acetabulum for 5 minutes after the acetabular preparation, another gauze was inserted in the femoral canal for 5 minutes after femoral canal broach preparation. The remaining 40 ml tranexamic acid fluid was injected into the hip joint after fascia closure. Place the drainage tube and clip it for 3 hours. Hemoglobin (Hb) and Hematocrit (Hct) were recorded at 72 hours after operation. The total blood loss, dominant blood loss, and hidden blood loss were calculated.</p><p><b>RESULTS</b>In group A, postoperative hemoglobin difference before and after operation was (32.34±7.42) g/L, total blood loss was (833.6±81.4) ml, the hidden blood loss was (276.3±57.9) ml, red blood cell volume was (10.1±1.4) L/L;In group B, hemoglobin difference before and after operation was (28.2±6.1) g/L, total blood loss was (792.5±61.8) ml, the hidden blood loss was (297.5±50.3) ml, red blood cell volume was (9.2±1.2) L/L. There was no statistical significance about those aspect (>0.05). Compared of blood coagulation function between two groups, in group A: PT (12.78±2.03) s, APTT (34.27±3.91) s, INR (32.34±7.42); and in group B: PT (13.17±2.19) s, APTT (32.36±3.18) s, INR (28.24±6.14). There was no significant differences also (>0.05).</p><p><b>CONCLUSIONS</b>Compared with intravenous application, topical application of tranexamic acid could also effectively reduce total blood loss and hidden blood loss, postoperative blood transfusion rate in primary total hip arthroplasty, while does not increase the risk of DVT.</p>
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Objective To assess the perioperative hidden blood loss in aged patients with femoral intertrochanteric fracture.Methods Clinical data of 243 patients (111 males and 132 females) with intertrochanteric fracture admitted from 2009 September to 2015 September were retrospectively reviewed.Two hundred and seventeen patients aged 60-98 years received surgical treatment and 26 patients aged 62-91 years received conservative treatment (non-surgical group).In surgical group,17 cases were operated within 1 d after fracture,71 within 3 d,73 within 7 d,31 within 14 d,and 25 cases were operated after 14 d.Hidden blood loss was evaluated and blood routine was tested.Results The hidden blood loss was (340 ± 216) ml in non-surgical patients,(602 ± 216) ml in patients operated after 14 d,(671 ± 327) ml in patients operated 8-14,(596 ± 362) ml in patients operated 4-7 d,and (505 ± 119) ml in patients operated 2-3 d,(498 ± 244) ml in patients operated within 1 d;there was significant difference among groups (F =14.758,P =0.001).The hemoglobin level in non-surgical group was (121.8 ± 17.6) g/Lwithin 1 d after fracture,(101.1 ±23.3) g/L on 1-3 d,(91.5 ±31.9) g/L on4-7 d,(92.2 ±31.6) g/L on 8-14 d,and (108.3 ± 22.4) g/L after 14 d;there was statistically significant among groups (F =12.457,P =0.001).Conclusions Hemoglobin level in elderly patients with femoral intertrochanteric fracture is dynamically changed,and reaches the lowest point within 1-2 weeks after injury;and operation is an important factor of hidden blood loss in femoral intertrochanteric fracture patients.
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Objective To explore the influence of tranexamic acid used in different modes in total hip arthroplasty (T HA ) blood loss by control experiment .Methods 60 patients accepted total hip arthroplasty from orthopaedics in our hospital were se‐lected between March 2010 to August 2013 ,among them femoral neck fracture were 47 cases and 13 cases were osteonecrosis .aged between 45‐82 years old ,and 62 in average .All gave unilateral total hip arthroplasty .All patients were divided into three groups ,A group(contradistinction group) ,B ,C group(experiment group) .each groups include 6 men and 14 women ,no revision surgery pa‐tients .For group A ,100 mL normal saline was dripped both in half on hour before surgery and 3 hours after surgery ;For group B , tranexamic acid diluted in 100 mL normal saline according to 10 mg/kg was dripped half on hour before surgery ,100 mL normal sa‐line was dripped 3 hour after surgery ;For group C ,tranexamic acid diluted in 100 mL normal saline according to 10 mg/kg was dripped both half on hour before surgery and 3 hour after surgery .Compute and record the visible blood cell loss and hidden blood loss ,the comparative analysis was conducted to discuss the effectiveness and safety of tranexamic acid used in the two methods .Re‐sults The visible blood cell loss in each group were (196 .20 ± 44 .45)mL ,(114 .84 ± 35 .21)mL and (104 .47 ± 30 .01)mL ;hidden blood loss in each group were:(614 .50 ± 98 .41)mL ,(425 .74 ± 70 .01)mL and (337 .12 ± 52 .23)mL .Conclusion In the unilateral total hip arthroplasty ,the use of tranexamic acid can significantly reduce a significant amount of visible and hidden blood loss .Com‐pared with tranexamic acid dripped just half one hour before surgery ,dripping tranexamic acid both half one hour before surgery and 3 hour after surgery reduced more hidden blood loss ,decreased transfusion requirement ,and this does not significantly increase the risk of deep venous thrombosis .
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Objective To analyze the features of hidden blood loss in the elderly femoral intertrochanteric fractures treated with extramedullary dynamic hip screw (DHS), intramedullary nails (Gamma 3, PFN) and hip arthroplasty (LBFH). Methods The clinicle records of 193 elderly patients (ages ≥75 year old) with femoral intertrochanteric fractures treat by DHS,Gamma3, PFNA and LBFH in our hospital were retrospectively analyzed. The estimated blood loss were calculated by Gross equation, according to the height,weight and changes of blood routine test reoperative and postoperative,the differences of hidden blood loss among DHS group,Gamma 3 group, PFN group and LBFH group were compared. Results Total blood loss in intramedullary nail groups were significantly higher than DHS group [(766 ± 83) mL],P 0.05), The hidden blood loss were significantly higher in the intramedullary nail groups than those in the LBFH group [(453 ± 98) mL,accounting 54%] and DHS group [(429 ± 59) mL,accounting 56%] (P 0.05). Conclusion Noteworthy, the hidden blood loss is major part of perioperative total blood loss in the elderly femoral intertrochanteric fractures , intramedullary fixations may result in greater hidden blood loss than extramedullary fixations and hip arthroplasty ,which may cause postoperative anemia.
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Objective To explore the influence factors of hidden blood loss during the treatment of femoral intertrochanteric fractures with percutaneous compression plate( PCCP) in elder patient. Methods The data of 136 patients with intertrochanteric fracture in our hos-pital from March 2009 to March 2012 treated with percutaneous compression plate were retrospectively analyzed,the effect of age,fracture type,preoperative aspirin,internal diseases on perioperative hidden blood loss, and different haemoglobin ( HGB) levels in patients with dif-ferent distribution were analyzed. Results The mean hidden blood loss volume was 499 mL,which accounted for 92. 54% of the total blood loss. The mean HGB decline was 11 g/L. The rate of on admisson haemoglobin level lower than 80 g/L was 6. 62% in AO type A2. 3 and A3 groups,and the rate of postoperative haemoglobin level lower than 80 g/L was 14. 70%. The average hidden blood loss for AO type A2. 3 (862 mL) and A3 (698 mL) were higher than those for AO types A1 (430 mL),A2. 1 (450 mL) and A2. 2 (415 mL) (P<0. 05). Multi-variate linear regression analysis showed that comminuted fracture and preoperative aspirin treatment were independently associated with in-creased perioperative hidden blood loss. Conclusion It indicated that the overt blood loss was fewer for PCCP operation. Intertrochanteric fracture was the main reason for substantial perioperative hidden blood loss. Types A2. 3 and A3 intertrochanteric fracture were early predic-tive factors of postoperative haemoglobin level lower than 80 g/L in elderly patients.
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Total knee arthroplasty is an important means of knee joint terminal disease , however , it has not been fully ob-served that there exists hidden blood loss in perioperative period , which greatly affects the function of patients with postoperative reha-bilitation exercise , increases the length of hospital stay , and increases the hospitalization expense .There is an urgent demand to im-prove patient satisfaction recovery .To avoid the perioperative blood loss that brings patients the adverse effects on postoperative rehabil -itation, we systemically reviewed the reviews of hidden blood loss after total knee replacement and analyzed the mechanism of hidden blood loss and its influencing factors .
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BACKGROUND:Hidden blood loss is an important risk for the intertrochanteric fracture patients, especial y the elderly patients, which can cause anemia in patients after internal fixation and can affect wound healing and patient recovery. OBJECTIVE:To compare the perioperative hidden blood loss and the risk factors of proximal femoral anti-rotation intramedul ary nail internal fixation and dynamic hip screw fixation for the treatment of femoral intertrochanteric fracture. METHODS:We selected 70 cases of femoral intertrochanteric fracture patients who treated with proximal femoral anti-rotation intramedul ary nail and dynamic hip screw fixation, including 21 patients with the age ≥ 80 years and 49 patients with the age30 kg/m2 and 42 patients with the body mass index ≤ 30 kg/m2;30 patients received anti-rotation intramedul ary nail internal fixation and 40 patients received dynamic hip screw fixation. The perioperative blood loss was calculated with Gross formula according to the changes of height, body mass index and the hematocrit before and after fixation. RESULTS AND CONCLUSION:The mean total blood loss was 936 mL, the mean dominant blood loss was 237 mL and the mean hidden blood loss was 699 mL. The hidden blood loss was accounted for 74.7%in total blood loss. The dominant blood loss in the dynamic hip screw fixation group was higher than that in the anti-rotation intramedul ary nail internal fixation group, and the hidden blood loss was lower than the anti-rotation intramedul ary nail internal fixation group. The total blood loss and the hidden blood loss of the elderly patients were higher than those of the non-elderly patients;there was no significant difference between male and female patients, obesity and normal patients. The results indicate that hidden blood loss is the major reason for total blood loss of femoral intertrochanteric fracture after internal fixation. The hidden blood loss of anti-rotation intramedul ary nail internal fixation is larger than that of dynamic hip screw fixation, and elder is the risk factor for hidden blood loss.
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[Objective]To study the correlated factors of hidden blood loss after simultaneous bilateral total knee arthroplasty.[Method]From Feb.2005 to Feb.2007,a retrospective analysis of 44 patients underwent knee arthroplasty was conducted to calculate the mean blood loss and occult blood loss according to Gross formula.The true total blood loss was calculated depending on height weight and pre-and post-operation HCT.[Result]The mean total blood loss were 2 065 ml in these cases with occult blood loss of 1 198 ml.In patients with autologous blood transfusion,the mean total blood loss were 2 180 ml with occult loss of 937 ml(42%).In patients without autologous blood transfusion,the mean total blood loss were 1 195 ml with occult blood loss of 799 ml(41%).[Conclusion]The hidden blood loss result in large volume of the total blood loss in the postoperative period which can not be fully compensated by autologous blood transfusion and it 's very important to additional blood supply during simultaneous bilateral total knee arthroplasty.