拇外翻术中局部应用氨甲环酸缓解术后肿胀的早期疗效

doi:10.19723/j.issn.1671-167X.2025.01.026

摘要/Abstract

摘要：

目的: 评估拇外翻术中截骨面局部应用氨甲环酸在减少术后隐性失血、进而缓解术后肿胀中的早期疗效。方法: 回顾性分析2022年7月11日至10月8日期间北京积水潭医院足踝外科收治的40例拇外翻行截骨矫形术的患者资料，其中男5例、女35例，依照患者纳入与排除标准筛选出32例患者，分为观察组16例(术中局部应用氨甲环酸)和对照组16例(术中未局部应用氨甲环酸)，按照术式将观察组与对照组患者一一配对，比较手术前后两组患者第一跖骨头前后径的变化量、足周径的变化量，以及术后CT测得的第一跖骨中分线长度和足底垂线长度，以评估术后切口周围的肿胀程度。第一跖骨中分线和足底垂线的测量参考籽骨位测量第一跖骨旋转角度的两条辅助线与软组织边界相交所得线段。共有三位临床医生完成了这两条线段的测量，并进行了观察者间的比较。结果: 通过观察者间的比较，CT测得第一跖骨中分线和足底垂线长度的一致性较高，可以认为是一种可靠的测量方式。经过配对t检验，观察组和对照组患者手术前后第一跖骨前后径的变化量差异无统计学意义(P>0.05)；观察组较对照组患者手术前后足周径的变化量更小，差异有统计学意义(P < 0.05)；观察组较对照组患者术后CT测得第一跖骨中分线和足底垂线的长度更小，差异有统计学意义(P < 0.05)。结论: 拇外翻截骨术中，截骨面局部应用氨甲环酸一定程度上缓解了术后肿胀，可能与氨甲环酸减少术后的隐性失血有关。

关键词: 氨甲环酸, 拇外翻, 局部给药, 肿胀

Abstract:

Objective: To evaluate the early efficacy of local application of tranexamic acid on the osteotomy surface during hallux valgus surgery in reducing postoperative occult blood loss and thus postoperative swelling. Methods: The data of 40 cases with hallux valgus osteotomy admitted to the Department of Foot and Ankle Surgery of Jishuitan Hospital from July 11, 2022 to October 8, 2022, including 5 males and 35 females were retrospectively analyzed. According to the inclusion and exclusion criteria, 32 cases were finally divided into 16 cases in the observation group (application of tranexamic acid) and 16 cases in the control group (no application of tranexamic acid). The observation group was paired with the control group one by one in accordance with the operation style, and the change in the anterior and posterior diameter of the first metatarsal head, the change in the circumferential diameter of the foot, the length of the first metatarsal midline and the length of the plumbline of the foot measured by postoperative CT were compared between the two groups before and after surgery, in order to evaluate the degree of swelling around the incision after the surgery. The first metatarsal midline and plumb line were measured by reference to the two auxiliary lines that intersect the soft tissue border in the sesamoid bone position to measure the rotation angle of the first metatarsal. A total of three clinicians completed the measurements of these two line segments and interobserver comparisons were performed. Results: By interobserver comparison, the consistency of the length of the midline of the first metatarsal and the plumbline measured by CT was high and could be considered a reliable measurement. After the paired t-test, there was no statistical difference in the amount of changes in the anteroposterior diameter of the first metatarsal before and after surgery between the observation and control groups (P>0.05), and the amount of changes in the circumferential diameter of the foot before and after surgery was smaller in the observation group than in the control group, which was statistically significant (P < 0.05); the length of the midline of the first metatarsal and the plumbline of the foot measured by CT after surgery was smaller in the observation group than in the control group, which was statistically significant (P < 0.05). Conclusion: Local application of tranexamic acid on the osteotomy surface during hallux valgus osteotomy can relieve postoperative swelling to some extent, which may be related to the fact that tranexamic acid reduces occult blood loss in the postoperative period.

Key words: Tranexamic acid, Hallux valgus, Topical administration, Swelling

中图分类号:

R687.3

孙宁, 王学文, 武勇, 任爽, 李恒, 杜辉, 龚晓峰. 拇外翻术中局部应用氨甲环酸缓解术后肿胀的早期疗效[J]. 北京大学学报（医学版）, 2025, 57(1): 172-177.

Ning SUN, Xuewen WANG, Yong WU, Shuang REN, Heng LI, Hui DU, Xiaofeng GONG. Early efficacy of local tranexamic acid in reducing postoperative swelling in hallux valgus surgery[J]. Journal of Peking University (Health Sciences), 2025, 57(1): 172-177.

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参考文献 16

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Group	n	Age/years, ${\bar x}$±s	Gender		Side		BMI/(kg/m²), ${\bar x}$±s	AOFAS forefoot score, ${\bar x}$±s
Group	n	Age/years, ${\bar x}$±s	Male	Female	Left	Right	BMI/(kg/m²), ${\bar x}$±s	AOFAS forefoot score, ${\bar x}$±s
Observation group	16	52.44±12.39	1	15	11	5	24.2±4.24	69.94±8.76
Control group	16	43.50±17.60	2	14	8	8	22.2±2.45	65.50±11.84
t		1.463					1.543	1.162
P		0.164	>0.999		0.180		0.144	0.263

Items	First metatarsal midline/cm, ${\bar x}$±s	Plumbline of the foot/cm, ${\bar x}$±s
Observer 1	4.15±0.60	4.22±0.66
Observer 2	4.14±0.57	4.21±0.63
Observer 3	4.19±0.56	4.24±0.64
ICC	0.988	0.987
95%CI	0.980-0.993	0.979-0.993
P	< 0.001	< 0.001

Group	Preoperative/cm, ${\bar x}$±s	Postoperative/cm, ${\bar x}$±s	Amount of change/cm, ${\bar x}$±s
Observation group	30.93±2.97	39.96±4.43	9.04±3.76
Control group	31.38±3.38	41.68±2.44	10.30±4.12
t	0.443	1.570	0.795
P	0.664	0.137	0.439

Group	Preoperative/cm, ${\bar x}$±s	Postoperative/cm, ${\bar x}$±s	Amount of change/cm, ${\bar x}$±s
Observation group	22.40±1.06	22.39±1.13	-0.012±0.43
Control group	22.71±1.19	23.16±1.00	0.44±0.72
t	0.806	2.529	2.521
P	0.433	0.023	0.023

Group	First metatarsal midline/cm, ${\bar x}$±s	Plumbline of the foot/cm, ${\bar x}$±s
Observation group	4.23±0.47	4.30±0.51
Control group	4.61±0.34	4.74±0.40
t	2.686	2.994
P	0.017	0.009