摘要目的:探讨氨甲环酸局部应用联合弹力绷带减少复杂胫骨平台骨折（Schatzker Ⅴ、Ⅵ）术后失血的效果观察。方法:采用电脑随机生成序列将2018年6月至2019年1月西安交通大学附属红会医院创伤骨科收治拟行手术的40例（男24例，女16例；年龄35~55岁，平均46.0岁）复杂胫骨平台骨折患者随机分为A、B两组。A组：手术切皮前5~10 min静脉注射生理盐水，术后不使用弹力绷带；B组：手术切皮前5~10 min静脉注射氨甲环酸15 mg/kg，术后使用弹力绷带加压包扎至膝上。记录比较两组患者的总失血量、隐性失血量、输血率、48 h引流量、静脉血栓性疾病、术后伤口并发症、术后疼痛模拟评分量表（VAS）评分及术后24 h D-二聚体值等情况。结果:A组和B组患者的年龄、性别、体重指数（BMI）、吸烟史、合并内科疾病情况、美国麻醉医师协会（ASA）评分、术前血红蛋白、术前红细胞压积、术前D-二聚体和纤维蛋白降解产物(FDP)差异均无统计学意义（ P>0.05），具有可比性。A组、B组患者术后24 h血红蛋白值分别为（104.6±10.4）、（113.3±11.9）g/L，术后48 h引流量分别为（277.1±229.2）、（207.1±124.3）mL，隐性失血量分别为（318.0±83.4）、（266.2±60.9）mL，总失血量分别为（792.8±202.8）、（692.2±124.9）mL，术后24 h D-二聚体值分别为（5.1±1.3）、（4.1±0.7）mg/L，术后VAS评分分别为（5.2±0.9）、（3.9±1.1）分，术后24 h下肢周径均值分别为（35.5±3.0）、（34.4±2.6）cm，术后72 h下肢周径均值分别为（33.8±2.1）、（32.8±2.3）cm，术后伤口瘀斑血肿率分别为20.0%（4例）和0（0例），住院时间分别为（6.6±1.0）、（6.2±1.2）d；以上指标两组间比较差异均有统计学意义（ P<0.05）。但A组与B组患在术后深静脉血栓形成(DVT)、肺栓塞及其他伤口并发症发生率比较差异均无统计学意义（ P>0.05）。 结论:氨甲环酸联合弹力绷带在复杂胫骨平台骨折中应用是合理且安全、有效的，可显著降低围手术期的失血量，且不增加血栓性疾病的发生率，有一定促进患者加速康复的积极作用。

abstractsObjective:To assess the effects of preoperative intravenous injection of tranexamic acid and postoperative local use of elastic bandage on blood loss in complex tibial plateau fractures (Schatzker types Ⅴ-Ⅵ).Methods:A sequence randomly generated by computer was used to randomize a cohort of 40 patients into 2 groups who were to receive surgery at Department of Orthopaedics and Trauma, Hong Hui Hospital from June 2018 to January 2019 for complex tibial plateau fractures. They were 24 men and 16 women, aged from 35 to 55 years (average, 46.0 years). In group A, intravenous injection of normal saline was conducted 5 to 10 min before surgical incision and no elastic bandage was used after surgery. In group B, a dose of 15 mg/kg tranexamic acid was intravenously given 5 to 10 min before surgical incision and elastic bandage was used to bandage the knee with compression after surgery. The 2 groups were compared in terms of total blood loss, hidden blood loss, transfusion rate, 48-h drainage flow, venous thromboembolism, postoperative wound complications, postoperative visual analogue scale (VAS), and D-dimer value 24 h after surgery.Results:There were no significant differences between the 2 groups in age, gender, body mass index, smoking history, concomitant medical conditions, American Society of Anesthesiologists (ASA) score, preoperative hemoglobin, preoperative hematocrit, preoperative D-dimerization or fibrin degradation products, showing comparability ( P>0.05). In groups A and B, hemoglobin values 24 h after surgery were 104.6 g/L ± 10.4 g/L versus 113.3 g/L ± 11.9 g/L, drainage volumes 48 h after surgery 277.1 mL ± 229.2 mL versus 207.1 mL ± 124.3 mL, hidden blood loss volumes 318.0 mL ± 83.4 mL versus 266.2 mL ± 60.9 mL, total blood loss volumes 792.8 mL ± 202.8 mL versus 692.2 mL ± 124.9 mL, D-dimer values 24 h after surgery 5.1 mg/L ± 1.3 mg/L versus 4.1 mg/L ± 0.7 mg/L, postoperative VAS scores 5.2 ± 0.9 versus 3.9 ± 1.1, lower limb cross-section diameters 24 h after surgery 35.5 cm ± 3.0 cm versus 34.4 cm ± 2.6 cm, lower limb cross-section diameters 72 h after surgery 33.8 cm ± 2.1 cm versus 32.8 cm ± 2.3 cm, postoperative rates of wound ecchymosis hematoma 20.0% (4 cases) versus 0 (0 cases), and hospital stays 6.6 d ± 1.0 d versus 6.2 d ± 1.2 d. There were significant differences between the 2 groups in all the above items ( P<0.05). However, there were no significant differences between the 2 groups in incidence of postoperative DVT, pulmonary embolism or other wound complications ( P>0.05). Conclusions:Preoperative intravenous injection of tranexamic acid and postoperative local use of elastic bandage is reasonable and safe for complex tibial plateau fractures, because it significantly reduces intraoperative blood loss but does not increase the risk of venous thromboembolism, and thus has a positive role in accelerating the recovery of patients.