Discussion
thrombosis, bleeding, intraoperative bleeding, paraspinal muscle
THROMBOSIS, BLEEDING, INTRAOPERATIVE HEMORRHAGE, INTRAOPERATIVE BLOOD LOSS, INTRAOPERATIVE BLEEDING, INFLAMMATORY RESPONSE
The main links of bleeding caused by PLIF include these steps, such as bleeding from the paraspinal muscle tissue during exposure, bleeding from the cancellous bone surface during laminectomy and decompression, and bleeding from the spinal venous plexus during intraspinal operation and posterior incision drainage results in blood lossVBL generally refers to intraoperative bleeding and postoperative drainage. The results of our study showed that the intraoperative blood loss, postoperative drainage, and VBL of the observation group were significantly smaller than those of the control group. It shows that the intravenous unit-dose of TXA can effectively reduce the VBL of PLIF. Theoretically, intraoperative hemorrhage will directly affect the clarity of the surgical field, which may prolong the operation time. However, our study found no significant difference in operative time between the two groups. We think there are two possible reasons for this result. First, our sample size is relatively small, which may affect the results. Second, it is possible that the surgeon's skill is good, so that the influence of intraoperative bleeding becomes less obvious.The HBL phenomenon was first discovered by Sehat et al.Generally speaking, the application of TXA reduces the intraoperative blood loss and postoperative drainage of patients, and also reduces the incidence of postoperative anemiaAlthough, the hemostatic mechanism of TXA relies on inhibition of the fibrinolytic system rather than promotion of coagulation, and theoretically does not increase the risk of thrombosis. The potential thrombosis risk of TXA is also a concern of clinicians while using TXA for hemostasisThe most commonly used method of TXA in spinal surgery is intravenousIn conclusion, intravenous unit-dose of TXA is safe and feasible in PLIF, it can reduce perioperative VBL and HBL, and it does not affect coagulation function and inflammatory response. However, this study also has shortcomings. This study is a small sample, single centre randomized clinical study.