Objective To explore the effect of local application of tranexamic acid (TXA) without drainage on blood loss in elderly patients with hip hemiarthroplasty. Methods A retrospective study was performed in 50 elderly cases of femoral neck fractures who had underwent hip hemiarthroplasty in department of Bone and Joint Surgery of Affiliated Hospital of Jining Medical University. Patients were randomly divided into the TXA group (n=25) and the control group (n=25). The TXA group received the intra-articular injection of 2 g TXA dissolved in 50 ml of normal saline, the control group received the intra-articular injection of the same volume of normal saline before closing the incision. The drainage tube was not used in both groups. The intraoperative blood loss, external blood loss, hidden blood loss, total blood loss, transfusion rate, postoperative hemoglobin concentration and complications were compared between the two groups. Results The postoperative hemoglobin concentrations in the TXA group were higher than those in the control group (t=7.473, t=7.226, t=7.572, P 0.05). Conclusion Local application of tranexamic acid (TXA) without drainage can effectively reduce perioperative blood loss and transfusion rate, and does not increase the incidence of complications in the elderly patients with hip hemiarthroplasty. Key words: Femoral neck fractures; Arthroplasty, replacement, hip; Tranexamic acid; Blood loss, sugical; Venous thrombosis
骨关节炎(OA)是关节软骨退变引起的一种全身的、慢性关节疾病,是造成成人残疾的主要原因,其特点是关节软骨退变引起软骨破坏、关节间隙变窄、软骨下硬化[1].关节软骨损伤是OA的基本病理过程,促进软骨修复、恢复软骨完整性对缓解或逆转OA极其重要.关节软骨没有血供,由于缺乏足够的营养物质,软骨再生的能力较弱,在其损伤后很难自愈;而且软骨细胞是成人关节软骨中唯一的细胞类型,是终末分化细胞,细胞增殖能力有限[2],而且随着年龄的增长,这种能力会逐渐减弱.近年来,在OA的研究和再生医学方面,干细胞治疗取得了迅速的进展.
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笔者于2018-01-09诊治脊髓空洞症合并Charcot关节病1例,报道如下. 1 病例报道 患者,女,57岁.因“右肩疼痛伴活动受限5个月”人院.查体:体温正常,右肩下垂,肩周压痛,活动受限明显,被动活动中可触及肱骨近端前后滑动,有半脱位感觉,关节不稳定.既往无糖尿病史.X线片显示右肱骨头部分缺如,内上移位.MRI显示C2～T4水平脊髓增粗,脊髓中央管扩张,内可见一纵行条索状、串珠状T1WI低信号,T2WI高信号影.诊断:右肩关节Charcot关节病;Chiari畸形并脊髓空洞症.由于患者脊髓空洞范围较大,在后颅窝减压术的基础上松解蛛网膜下腔,开放第4脑室正中孔,保证脑脊液流出;去除脑干的骨性束缚和解除疝出物导致的硬膜压迫,重建枕骨大孔的正常脑脊液动力学,消除脊髓空洞症;Charcot关节病采用非手术治疗,给予非甾体抗炎药并用支具固定肩关节,避免关节活动,应用抗生素预防和控制感染.术后随访3个月,未出现脊髓空洞症进展及其他神经性关节病变迹象.
