Efficacy of intravenous drip combined with intra-articular injection of different concentrations of tranexamic acid in patients with complex tibial plateau fractures

WU Xiao-dong; REN Peng-peng; ZHOU Wen-bin

doi:10.3969/j.issn.2095-252X.2025.06.004

Abstract：Objective To analyse the efficacy of intravenous drip(IV)combined with intra-articular injection(IA)of different concentrations of tranexamic acid(TXA)in patients with complex tibial plateau fractures(CTPF).Methods 82 patients with CTPF admitted to our hospital between February 2022 and February 2024 were selected.The patients were divided into a low-dose group(IV TXA 1 g,IA TXA 1 g)and a high-dose group(IV TXA 1 g,IA TXA 2 g)according to the random number table method,with 41 cases each.We compared the perioperative indexes(duration of surgery,intraoperative blood loss,occult blood loss,drainage fluid volume,tourniquet use time,intraoperative rehydration volume,length of hospitalization,postoperative blood indices at 72 h and complications),inflammatory response status[tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),IL-6 and IL-10]and knee function[knee society score(KSS),Lysholm score,International Knee Documentation Committee(IKDC),Tegner score,knee range of motion(ROM)]between the two groups.Results The amount of occult blood loss and postoperative drainage fluid were lower in high-dose patients than in patients in the low-dose group(P<0.05),and Hb was higher than in low-dose patients(P<0.05).TNF-α was higher in high-dose patients than in patients in the low-dose group 30 mins,1 day and 2 days postoperatively(P<0.05).IL-6 was higher than in low-dose patients 30 mins postoperatively(P<0.05).At 3M and 6M postoperatively,HSS,Lysholm,IKDC,Tegner score and ROM were higher in high-dose patients than in low-dose patients(P<0.05).Conclusions IV TXA 1 g combined with IA TXA 2 g has better haemostatic effect and knee function in the treatment of patients with CTPF,but it could lead to increased postoperative inflammatory response,which needs to be further investigated to see whether this phenomenon is beneficial to patients'postoperative recovery and to guide the rational use of TXA in the clinic.