Application Of Tranexamic Acid In Perioperative Period Of Complex Tibial Plateau Fractures And Postoperative Follow-up Study

Object: To investigate the application of tranexamic acid intravenous infusion scheme in patients with complex tibial plateau fractures(Schatzker V,VI)during perioperative period and follow-up study of postoperative pain,knee function and quality of life.Method: A retrospective analysis of the data of 48 patients with complex tibial plateau fractures who met the inclusion criteria of this study from September 2016 to November 2019.Patients were divided into TXA group and control group according to whether tranexamic acid(TXA)was applied during the perioperative period.The TXA group was given a total of 1 g of TXA 30 minutes before surgery and 5-10 minutes before loosening the tourniquet;the control group was given the same amount of normal saline.Blood routine and coagulation tests were performed on the first and third postoperative days to compare changes in hemoglobin,hematocrit,D-dimer,and fibrinogen.The tourniquet use time,total drainage volume,intraoperative blood loss,total blood loss,hidden blood loss,and allogeneic blood transfusion rate were compared between the two groups;the occurrence of thromboembolic events,incision complications,and adverse reactions within 12 weeks after operation.VAS(visual analogue scale,VAS)pain visual analog scale,SF-12(the MOS item short from health survey,SF-12)quality of life scale and knee joint HSS(Hospital for special surgery,HSS)score scale Assess patient prognosis.Result: A total of 48 patients were included in the study,39 males and 9 females,with a male-to-female ratio of 4.33: 1;aged 21 to 56,with an average age of 43.45 ± 3.18 years.There was no significant difference in baseline data between the two groups(P> 0.05).There was no significant difference in tourniquet use time and operation time between the two groups(P> 0.05).The reduction of Hb in the TXA group was(8.40 ± 4.11 g / L),and the control group was(11.31 ± 5.06 g / L).The total blood loss was calculated in the TXA group(484.95 ± 49.53 ml),and the control group(643.94 ± 34.27 ml);hidden Sexual blood loss was calculated in the TXA group(147.88±46.82 ml)and in the control group(191.96 ± 39.25 ml).The above indexes were statistically significant among the groups(P <0.05 or P<0.001).There was no statistical difference between the two groups in terms of blood loss,allogeneic blood transfusion rate,postoperative blood tests,coagulation test results,thromboembolic events,incision complications,and adverse reactions(P> 0.05).The PCS score of patients in the TXA group at 6 weeks after surgery was significantly higher than that of the control group(P <0.05).Conclusion: Intravenous infusion of TXA regimen in patients with complex tibial plateau fractures can effectively prevent hemoglobin loss,reduce perioperative blood loss.Under the premise of reasonable use of TXA,it does not increase the risk of postoperative thromboembolic events,and has an advantage in improving the quality of life after surgery.