Abstract:

Objective: To investigate the clinical value of intravenous and local application of tranexamic acid (TXA) in perioperative period of lumbar tuberculosis. Methods: A total of 92 lumbar tuberculosis patients admitted to Qingdao Chest Hospital from January 2019 to January 2022 were prospectively analyzed. They were randomly divided into observation group (n=46) and control group (n=46). In the observation group, 0.5 g (5 ml) TXA was injected intravenously before operation, and 0.5 g of TXA was given once within 12 hours after operation. During the operation, 0.5 g of TXA was sprayed in each cavity (including small incision of lumbar posterior approach, oblique anterior incision of lumbar spine and incision of iliac bone extraction area). In the control group, 0.5 g TXA was injected intravenously before operation, and 0.5 g was given intravenously before surgery and 0.5 g intravenously within 12 hours after surgery. Patients in both groups underwent lumbar obliquely anterior approach diseased vertebra removal and iliac bone grafting fusion. The intraoperative bleeding volume, operation duration, drainage volume 24 hours and 72 hours after operation, hematocrit 3 days after operation, hemoglobin decrease 3 days after surgery, blood D-dimer (D-D) level 1 week after surgery, coagulation function (prothrombin time, activated partial thrombin time) and other related indicators were compared between the two groups. Results: All the 92 patients successfully completed the operation and no deep vein thrombosis was found by color Doppler ultrasonography of lower extremity veins. There was no significant difference in operation duration and intraoperative bleeding between the two groups ((149.0±23.8) min vs. (145.0±26.3) min, t=0.765, P=0.443; (344.0±120.0) ml vs. (360.0±134.0) ml, t=0.603,P=0.402). The drainage volume 24 hours and 72 hours after operation, and the decrease of hemoglobin 3 days after operation in the observation group were significantly lower than those in the control group ((64.0±23.3) ml vs. (77.0±33.1) ml, t=2.178, P=0.042; (159.0±25.2) ml vs. (174.0±27.2) ml, t=2.743, P=0.032; (28.2±8.1)g/L vs. (32.5±9.6)g/L, t=2.324, P=0.037, respectively). The erythrocyte specific volume in the observation group [(32.1±8.3) %] was higher than that in the control group ((28.2±10.2) %), the difference was statistically significant (t=2.014, P=0.048). There was no significant difference in the incidence of gastrointestinal reactions, prothrombin time 3 days after surgery, activated partial prothrombin time and blood D-D level 1 week after surgery between the two groups (8.7% (4/46) vs. 10.9% (5/46), χ²=0.123, P=0.212; (13.1±3.2) s vs. (12.6±2.9) s, t=0.835, P=0.517; (36.1±6.1) s vs. (34.6±5.6) s, t=1.229, P=0.224; (0.9±0.2) mg/L vs. (0.9±0.3) mg/L, t=0.366, P=0.712, respectively). Conclusion: Intravenous and local application of TXA could effectively reduce the blooding volume in the operation of lumbar tuberculosis, reduce the amount of blooding after surgery, and not increase the risk of postoperative thrombosis, so that patients could achieve the goal of rapid rehabilitation.

Key words: Lumbar vertebrae, Tuberculosis, Tranexamic acid, Surgical procedures,minimally invasive, Rehabilitation