The Application Of Intravenous Injection Of Tranexamic Acid Combined With Local Use Of Tranexamic Acid Cocktail In The Treatment Of PFNA

Objective:To explore the efficacy and safety of Intravenous injection tranexamic acid(TXA)combined with tranexamic acid cocktail therap(local injection of TXA、ropivacaine and adrenaline)infiltration in femoral intertrochanteric fracture fixation with proximal femoral nail antirotation(PFNA)with enhanced recovery after surgery ERAS program.Methods:A total of 45 patients who underwent PFNA with ERAS program were randomly divided into the 3 group.Group B(15 patients,control group)that received intravenous injection of TXA(1 gTXA+100mL saline,15 minutes before the surgery),group C(15patients,experimental group)that received received intravenous injection of TXA before the surgery,and local infiltration with tranexamic acid cocktail therap(50ml saline+1g TXA+0.1g adrenaline)before intramedullary fixation.Before suture,50 ml(50 ml saline+1 g tranexamic acid+100 mg ropivacaine+0.1 mg adrenaline)was injected into the soft tissue around the incision.Group A(15 patients,blank control group)received the same amount of saline before operation.The total blood loss,dominant blood loss,recessive blood loss,transfusion rate,operation time,visual analogue scale(VAS)pain score,Maximum amplitude of thromboelastogram(MA),postoperative complications and embolism events during 2 weeks’ follow-up were recorded and compared.The expression of inflammatory factors(Prostaglandin E2,(Bradykinin)was measured and recorded by ELISA on the 1st and 3rd day after operation.Results:The total blood loss and recessive blood loss in group C were less than group A and B,with statistical significance(P<0.05);the dominant blood loss and transfusion rate in group B and C were significantly less than those in group A(P<0.05);there was no significant difference in the dominant blood loss and transfusion rate between group B and C(P>0.05);there was no significant difference in the operation time among the three groups(P>0.05).The VAS score,PGE and BK levels on the first and third day after operation in group C were lower than group A and B,and the difference was statistically significant.There were no significant differences in complications(χ2=1.721,P=0.550),MA and incidence of deep venous thrombosis in lower extremities among the three groups.Conclusions Intravenous injection of tranexamic acid combined with tranexamic acid cocktail therap infiltration in older intertrochanteric fracture patients treated with PFNA in ERAS program can reduce blood loss during perioperative period,relieve pain after operation but will not increase the risk complications.Conclusion:Intravenous injection of tranexamic acid combined with tranexamic acid cocktail therap infiltration in older intertrochanteric fracture patients treated with PFNA in ERAS program can reduce blood loss during perioperative period,relieve pain after operation but will not increase the risk complications.