Original ArticleDifferent Effects of Intravenous, Topical, and Combined Application of Tranexamic Acid on Patients with Thoracolumbar Fracture
Introduction
With the development of minimally invasive spinal surgery, the percutaneous pedicle screw technique has been extensively applied in clinic. Compared with traditional open surgery, minimally invasive percutaneous pedicle screw fixation can attain comparable clinical efficacy in treating thoracolumbar fractures, but it has exhibited obvious advantages in terms of operation time, intraoperative blood loss (IBL), and length of stay.1, 2 However, previous studies3, 4 have only focused on blood loss, such as IBL and postoperative drainage, and few of them have reported total blood loss (TBL) and hidden blood loss (HBL). HBL can lead to postoperative anemia, which will thereby affect postoperative functional recovery and increase the risk of incidence of complications.5, 6 As a result, it remains urgent to solve the problem of reducing the HBL amount in treatment of thoracolumbar fractures through minimally invasive percutaneous pedicle screw fixation. Tranexamic acid (TXA), a commonly used hemostatic agent in orthopedic surgery, has also been extensively applied in spine surgery.7 Moreover, the effectiveness of TXA on preoperative intravenous infusion or topical use has also been verified by relevant studies.8, 9, 10, 11 However, no existing literature has reported the effect of TXA on reducing perioperative blood loss in treating thoracolumbar fractures by minimally invasive percutaneous pedicle screw fixation.12 In this prospective and single-blind study, 181 patients undergoing minimally invasive percutaneous pedicle screw fixation for thoracolumbar fracture with no nerve injury were randomly selected from our department from January 2016 to December 2017 and were divided into 3 groups to assess the best way for application of TXA.
Section snippets
Patients
From January 1, 2017, a total of 185 patients were included and divided into an intravenous group (group A), topical group (group B), and combined group (group C), according to a random number table. Patients were asked to randomly select a number plate ranging from 1 to 185 preoperatively; among them, 1–62 were in group C, 63–124 were in group B, and 125–185 were in group A. Meanwhile, 4 of the 185 patients were lost to follow-up (Figure 1). For the 61 cases in the intravenous group,
Outcome Measures and Statistical Analysis
For evaluation during the perioperative period, the time from injury to surgery, preoperative hematocrit (Hct), postoperative Hct, preoperative D-dimer, and D-dimer at 72 hours after surgery were recorded. Meanwhile, the presence of DVT in bilateral lower limbs was confirmed by ultrasound examination at 24 hours before surgery and 72 hours after surgery. Complications, including hematoma, infection, DVT, pulmonary embolism, myocardial ischemia, and ischemic encephalopathy, were also recorded at
Results
The operations were successfully performed in all patients. No wound infection, nerve injury, or other secondary operation was reported at 1 week after surgery. There were 61 cases in the intravenous group, including 34 men and 27 women, with an age of 45.43 ± 8.18 years and body mass index (BMI) of 21.26 ± 2.26 kg/m2. Regarding the fracture sites, 4 cases were at T11, 16 were at T12, 30 were at L1, and 11 were at L2. The time from injury to surgery was 4.27 ± 2.00 days.
There were 61 patients
Discussion
As one of the representative minimally invasive spinal surgical techniques, the percutaneous pedicle screw technique has been extensively applied in clinic. Existing studies suggest2 that treating thoracolumbar fracture with no neurologic symptoms by percutaneous pedicle screw is associated with the advantages of short operation time, less IBL, less soft tissue damage, and rapid postoperative recovery. However, perioperative HBL is neglected. There is no postoperative drainage when treating
References (23)
- et al.
Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: systematic review and meta-analysis of comparative studies
Clin Neurol Neurosurg
(2015) - et al.
Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis
Spine J
(2015) - et al.
Hidden blood loss during posterior spine fusion surgery
Spine J
(2013) - et al.
Leg position influences early blood loss and functional recovery following total knee arthroplasty: a randomized study
Int J Surg
(2015) - et al.
Tranexamic acid in hip fracture surgery: a randomized controlled trial
Br J Anaesth
(2010) - et al.
Venous thromboembolism and mortality associated with tranexamic acid use during total hip and knee arthroplasty
J Arthroplasty
(2015) - et al.
Percutaneous versus open pedicle screw fixation for treatment of type A thoracolumbar fractures [e-pub ahead of print]
Eur J Trauma Emerg Surg
(2018) - et al.
Comparison of clinical results between novel percutaneous pedicle screw and traditional open pedicle screw fixation for thoracolumbar fractures without neurological deficit [e-pub ahead of print]
Int Orthop
(2018) - et al.
[Percutaneous pedicle screw fixation and minimally invasive decompression in the same incision for type A3 thoracolumbar burst fracture]
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi
(2017) - et al.
Hidden blood loss and its influencing factors after percutaneous kyphoplasty surgery
Medicine
(2018)
Hidden blood loss and the influential factors after percutaneous kyphoplasty surgery
Eur Spine J
Cited by (0)
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.