Traneksamik asitin lokal ve intravenöz uygulanmasının Tibia Fraktürlerinin kaynaması üzerine etkilerinin değerlendirilmesi : Deneysel çalışma
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Dosyalar
Tarih
2019
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/embargoedAccess
Özet
Bu deneysel çalışmada transemik asitin antienflamatuar ve hematom miktarını azaltıcı etkisi nedeniyle kırık kaynaması üzerinde oluşabilecek etkilerini değerlendirmeyi amaçladık. Bu deneysel çalışma Trakya Üniversitesi Tıp Fakültesi Deney Hayvanları ve Araştırma laboratuvarından elde edilen 42 adet Sprague-Dawley cinsi rat üzerinde gerçekleştirildi. Deney grupları; randomize olarak seçilmiş her biri 14 rattan oluşan kontrol grubu, traneksamik asitin lokal uygulandığı ve intravöz uygulandığı 3 grup oluşturuldu. Bu 3 gruptan 14. ve 21. günlerde radyolojik ve histolojik inceleme için 7’şerli 6 alt grup oluşturuldu. Deneyin ilk günü tüm ratlarda (n=42) tibia orta 1/3 diyafiz yumuşak dokudan korunarak transvers kırık oluşturuldu ve bu kırığın Kirschner teli yardımıyla intramedüller tespiti sağlanarak tibia kırık modeli oluşturuldu. Tibia kırık modeli oluşturulan Grup K1 ve Grup K2’deki ratlar kontrol grubu olarak belirlendi. Grup L1 ve Grup L2’deki ratların kırık bölgesine 50 mg/kg lokal, Grup I1 ve Grup I2’deki ratların kuyruk venlerinden 50 mg/kg intravenöz olarak traneksamik asit uygulandı. Çalışmanın 1. ve 3. gününde tüm gruplardaki ratların hemotom hacminin değerlendirilmesi için ultrasonografileri çekildi. Çalışmanın 14. ve 21. gününde kırık iyileşmesinin değerlendirilmesi için ratların mamografi cihazı yardımıyla direkt radyografileri çekildi. Çekimlerin tamamlanmasından sonra ratlar anestezi altında iken servikal dislokasyon+açık pnömotoraks oluşturularak sakrifiye edildi. Ratlar sakrefiye edildikten sonra femur orta 1/3ten diseke edilerek alt ekstremitenin distaline ait piyesler histolojik inceleme için %10 formaldehit içerisinde Patoloji Anabilim Dalı’na teslim edildi. Hematom hacimleri bakımından postoperatif 1. günde gruplar arasında anlamlı bir farkın olmadığı bulunurken; postoperatif 3. günde lokal olarak traneksamik asit uygulanan grupta ölçülen hematom hacimleri ortalamasının kontrol ve intravenöz olarak traneksamik asit uygulanan gruplara göre anlamlı derecede yüksek olduğu, kontrol ve intravenöz olarak traneksamik asit uygulanan grupların ise benzer olduğu bulundu. Postoperatif 1.güne göre 3. gündeki hematom rezorbsiyon oranları bakımından gruplar arasında anlamlı farkın olmadığı bulundu. 14. ve 21. günlerdeki radyolojik ve histolojik kemik iyileşmesi değerlendirildiğinde; kemik formasyonu, kaynama derecesi, remodalizasyon derecesi, toplam radyolojik skor ortalamaları ve histolojik skorlarının dağılımları bakımından anlamlı farkın olmadığı bulundu. Sonuç olarak; 50 mg/kg lokal ve intravenöz olarak uygulanan traneksamik asit postoperatif 1. günde ölçülen kırık bölgesi hematom hacimleri arasında anlamlı bir farkın olmadığı bulunurken, 3. günde ölçülen hematom hacimlerinin lokal olarak traneksamik asit uygulanan grupta kontrol ve intravenöz olarak traneksamik asit uygulanan gruplara göre anlamlı derecede yüksek olduğu bulunmuştur. Ratların 14. ve 21. günlerde değerlendirilen radyolojik ve histolojik skorlarının etkilemediği görülmüştür. Traneksamik asit lokal ve intravenöz olarak uygulanması kırık iyileşmesini etkilemediği düşündürmektedir.
In this experimental study, we aimed to evaluate the effects of tranexamic acid on fracture healing, due to the antiinflammatory effects and hematoma reducing effects of tranexamic acid. This experimental study was carried out on 42 Sprague-Dawley rats, which were obtained from the Experimental Animals and Research Laboratory of the Faculty of Medicine of Trakya University. Experimental groups were formed of; 3 groups control group consisting of 14 random rats selected as randomized, locally tranexamic acid administered group and intravenously tranexamic acid administered group. On the 14th and 21 th days of these 3 groups, 6 subgroups were created for radiological and histological examination. On the first day of the experimental study, a transverse fracture was formed in all rats (n = 42) by preserving the middle 1/3 diaphyseal soft tissue of tibia and a tibia fracture model was formed by providing intramedullary fixation with this Kirschner wire. The rats in group K1 and group K2, in which the tibia fracture pattern was formed, were determined as the control group. Tranexamic acid was administered 50 mg / kg locally to the fractured area of the rats in Group L1 and Group L2, and 50 mg / kg intravenously from the tail veins of the rats in Group I1 and Group I2. On the first and third days of the study, ultrasonography was performed to evaluate the hematoma volume of rats in all groups. On the 14th and 21th days of the study, direct radiographs were taken with the aid of a mammography device for the evaluation of fracture healing. After completion of the shots, the rats were anesthetized and sacrificed by cervical dislocation + open pneumothorax. After the rats were sacrificed, the femur was disrupted from the midshaft 1/3, and the distal part of the lower extremity was delivered to the Pathology Department in 10% formaldehyde for histological examination. There was no significant difference in hematoma volume between the groups on postoperative first day; it was found that the mean hematoma volumes measured in the locally administered tranexamic acid group on the postoperative third day were significantly higher than control and intravenous tranexamic acid treated groups and the tranexamic acid treated groups were similar in the control and intravenous groups. According to postoperative 1st day, it was found that there was no significant difference between the groups in terms of hematoma resorption rates in the 3rd day. When the radiological and histological bone healing on the 14th and 21th days was evaluated, bone formation, union grade, remodalization grade, total radiological score averages and histologic scores were not significantly different. As a result; 50 mg/kg intravenously and locally administered TA was not significantly different between the fracture zone hematoma volumes measured on postoperative first day and the hematoma volumes measured on third day were significantly higher in the locally tranexamic acid administered group than in the intravenously tranexamic acid-administered groups and the control groups. It was observed that the radiological and histological scores at the 14th and 21th days of the rats were not affected. The application of tranexamic acid locally and intravenously suggests that it does not affect fracture healing.
In this experimental study, we aimed to evaluate the effects of tranexamic acid on fracture healing, due to the antiinflammatory effects and hematoma reducing effects of tranexamic acid. This experimental study was carried out on 42 Sprague-Dawley rats, which were obtained from the Experimental Animals and Research Laboratory of the Faculty of Medicine of Trakya University. Experimental groups were formed of; 3 groups control group consisting of 14 random rats selected as randomized, locally tranexamic acid administered group and intravenously tranexamic acid administered group. On the 14th and 21 th days of these 3 groups, 6 subgroups were created for radiological and histological examination. On the first day of the experimental study, a transverse fracture was formed in all rats (n = 42) by preserving the middle 1/3 diaphyseal soft tissue of tibia and a tibia fracture model was formed by providing intramedullary fixation with this Kirschner wire. The rats in group K1 and group K2, in which the tibia fracture pattern was formed, were determined as the control group. Tranexamic acid was administered 50 mg / kg locally to the fractured area of the rats in Group L1 and Group L2, and 50 mg / kg intravenously from the tail veins of the rats in Group I1 and Group I2. On the first and third days of the study, ultrasonography was performed to evaluate the hematoma volume of rats in all groups. On the 14th and 21th days of the study, direct radiographs were taken with the aid of a mammography device for the evaluation of fracture healing. After completion of the shots, the rats were anesthetized and sacrificed by cervical dislocation + open pneumothorax. After the rats were sacrificed, the femur was disrupted from the midshaft 1/3, and the distal part of the lower extremity was delivered to the Pathology Department in 10% formaldehyde for histological examination. There was no significant difference in hematoma volume between the groups on postoperative first day; it was found that the mean hematoma volumes measured in the locally administered tranexamic acid group on the postoperative third day were significantly higher than control and intravenous tranexamic acid treated groups and the tranexamic acid treated groups were similar in the control and intravenous groups. According to postoperative 1st day, it was found that there was no significant difference between the groups in terms of hematoma resorption rates in the 3rd day. When the radiological and histological bone healing on the 14th and 21th days was evaluated, bone formation, union grade, remodalization grade, total radiological score averages and histologic scores were not significantly different. As a result; 50 mg/kg intravenously and locally administered TA was not significantly different between the fracture zone hematoma volumes measured on postoperative first day and the hematoma volumes measured on third day were significantly higher in the locally tranexamic acid administered group than in the intravenously tranexamic acid-administered groups and the control groups. It was observed that the radiological and histological scores at the 14th and 21th days of the rats were not affected. The application of tranexamic acid locally and intravenously suggests that it does not affect fracture healing.
Açıklama
Anahtar Kelimeler
Traneksamik Asit, Kemik İyileşmesi, Hematom, Antifibrinolitik, Tranexamic Acid, Bone Healing, Hematoma, Antifibrinolytic
