Role of preoperative administration of tranexamic acid in the treatment of senile proximal humeral fracture with locking plate internal fixation / 中华创伤杂志

ABSTRACT

Objective:To explore the efficacy and safety of preoperative application of tranexamic acid (TXA) in the treatment of senile proximal humeral fracture (PHF) with locking plate internal fixation.Methods:A prospective randomized controlled analysis was performed on clinical data of 89 elderly patients with PHF admitted to First Affiliated Hospital of Chongqing Medical University from December 2018 to December 2021. All patients received open reduction and locking plate internal fixation. The patients were divided into TXA group and control group according to the equal probability randomization method. In TXA group, the patients were given 1 g of TXA intravenously at 30 minutes before operation. In control group, the patients were given the same amount of normal saline at the same time. The general data (sex, age, body mass index, bone mineral density, Neer classification, and time from injury to operation), operation time, hospitalization time, and postoperative complications were recorded and compared between the two groups. At 3 months after operation, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and shoulder range of motion (ROM) were used to compare the recovery of shoulder joint function between the two groups. The total blood loss (TBL), visible blood loss (VBL), hidden blood loss (HBL), intraoperative blood loss (IBL), postoperative drainage volume, drainage tube removal time and blood transfusion rate were compared between the two groups.Results:There were 47 patients in TXA group and 42 patients in control group. There were no significant differences in general data between the two groups (all P>0.05). The operation time and incidence of deep vein thrombosis (DVT) showed no significant difference between the two groups (all P>0.05). The hospitalization time was (7.4±2.5)days in TXA group, significantly shorter than (10.9±3.1)days in control group ( P<0.05). The wounds were healed at stage I in the two groups, with no incision infection, pulmonary embolism, cerebral embolism or other critical complications. There were no significant differences in ASES score, Constant-Murley score and shoulder ROM between the two groups at 3 months postoperatively (all P>0.05). In TXA group, the TBL, VBL, HBL, postoperative drainage volume and drainage tube removal time were (341.1±31.2)ml, (198.7±20.2)ml, (142.5±23.8)ml, (38.9±12.9)ml, and (25.6±3.2)hours respectively, while in control group, the TBL, VBL, HBL, postoperative drainage volume and drainage tube removal time were (643.7±42.4)ml, (223.1±28.6)ml, (420.6±31.8)ml, (58.9±16.9)ml, and (37.3±5.3)hours respectively ( P<0.05 or 0.01). There were no significant differences in IBL or blood transfusion rate between the two groups (all P>0.05). Conclusions:For senile PHF treated with locking plate internal fixation, preoperative intravenous infusion of TXA can effectively shorten the hospital stay, without increasing the incidence of DVT or affecting shoulder joint function. Meanwhile, TXA results in reduced TBL, VBL, HBL and postoperative drainage volume and early drainage tube removal, which has good clinical effectiveness and safety.