聂海涛,李钊伟

踝关节骨折是骨科常见创伤，手术治疗可有效恢复关节解剖结构，但围手术期隐性失血易被忽视，可能导致贫血、切口愈合延迟等不良结局，影响患者预后。本文通过检索近10年国内外相关文献，从踝关节骨折围手术期隐性失血的发生机制、氨甲环酸的作用原理入手，系统分析氨甲环酸在减少该类患者隐性失血中的临床证据、给药方案、安全性及现存争议，旨在为临床规范应用氨甲环酸、优化踝关节骨折围手术期管理提供参考。结果表明，围手术期合理使用氨甲环酸可显著降低踝关节骨折患者的隐性失血量、术后贫血发生率及输血需求，且不显著增加血栓风险；不同给药途径（静脉滴注、局部浸润、关节腔内注射）及给药时机均有明确疗效，其中“术前静脉滴注+术中局部浸润”联合方案效果更优。未来需进一步开展大样本、多中心随机对照试验，探索个体化给药方案及长期预后影响，以完善氨甲环酸在踝关节骨折治疗中的应用证据链。

踝关节骨折；围手术期；隐性失血；氨甲环酸；抗纤溶治疗；临床疗效

[1] 朱波,张彬,吴健.Endobutton带袢钢板弹性固定在踝关节骨折合并下胫腓联合韧带损伤中的应用效果[J].中国现代医学杂志, 2025,35(20):15-20. [2] 谭杨,徐艳文,管美萍,等.雷火灸联合主动疼痛管理在踝关节骨折术后的临床应用研究[J].中国现代医学杂志,2025,35(20):46-52. [3] 申林,李克锋,田恩赛,等.“筋骨并重”原则指导下手术治疗青壮年踝关节骨折的效果[J].医药前沿,2025,15(29):100-103. [4] 曹云平,陈涛,高强,等.袢钢板治疗踝关节骨折合并下胫腓联合损伤[J].生物骨科材料与临床研究,2025,22(05):60-63+74. [5] 季绍振,雷建毅,郭剑波,等.改良Rammelt经外踝骨折线入路复位后踝骨折的疗效观察[J/OL].中国修复重建外科杂志, 1-6[2025-10-22]. [6] Tang K,Huang L,Lin X,et al.Effect of early weight bearing on rehabilitation in ankle fractures with syndesmotic injuries[J].Scientific Reports,2025,15(1):34957-34957. [7] Nienhaus M,Kronfeld K,Schulowski O,et al.The CAM-P-OS study protocol:a prospective randomized multicenter trial evaluating an active controlled motion device in the rehabilitation of surgically treated,isolated ankle fractures of Weber types B and C[J].Trials, 2025,26(1):388-388. [8] 朱雅萍,魏金聚,宋磊军,等.踝关节骨折术腓肠肌平面阻滞的镇痛作用[J].中国矫形外科杂志,2025,33(19):1817-1820. [9] Zhang J L.Factors associated with hospitalization for emergency ankle fractures and the development and validation of a predictive model[J].Medicine,2025,104(40):e44789-e44789. [10] Benjamin B,Mary J J,N.J B,et al.Fibular Intramedullary Nailing in Ankle Fracture Management:A Contemporary Surgical Approach[J]. JBJS Journal of Orthopaedics for Physician Assistants,2025,13(4):e25.00015-e25.00015. [11] D.J M.CORR Insights®:Is 2-week Cast Wearing Followed by 4-week Functional Bracing Superior to 6-week Cast Immobilization After Surgery for Ankle Fractures?A 2-year Follow-up of a Randomized Controlled Trial[J].Clinical Orthopaedics&Related Research,2025, 483(10):1888-1890. [12] 青鹰,额尔克木宝勒尔,阿其拉图.蒙医药治疗踝关节骨折术前肿胀的新探索及优势解析[J].中国民族医药杂志,2025,31(09):72-74. [13] 姜千惠,桑义民.加速康复外科理念在老年骨质疏松性踝关节骨折中的应用进展[J].现代医学与健康研究电子杂志,2025,9(18):121-124. [14] Hor T W,Liu Y,Chua A,et al.Risk factors for complications after ankle fracture surgery:a review of 531 cases[J].European Journal of Orthopaedic Surgery&Traumatology,2025,35(1):405-405. [15] 董思珍,齐武林,吴世良.术后负重时机对踝关节骨折术后功能康复的影响[J].浙江创伤外科,2025,30(09):1659-1661. [16] Ma Q F,Liu C Y,Wang Y X.[Treatment progress and clinical strategies for ankle fractures combined with diabetes mellitus].[J]. Zhongguo gu shang=China journal of orthopaedics and traumatology,2025,38(9):976-980. [17] 孟祥坤,扈延龄,王加利.踝关节镜下联合牵开器精准治疗后踝骨折[J].实用骨科杂志,2025,31(09):850-854. [18] Wang J,Yang K,Liu Z,et al.Supination adduction stage 2 associated with transverse fracture of the lateral malleolus and rupture of the anterior talofibular ligament:a case report and literature review[J].Frontiers in Surgery,2025,12 1658026-1658026. [19] 冯绍吉,何博,裴畅,等.外踝撕脱性骨折在行走支具保护下即刻负重对踝关节功能康复的影响研究[J].延边大学学报(自然科学版),2025,51(03):159-164. [20] 范李珍,张福杰,樊孝文,等.临床护理路径模式对踝关节骨折手术患者的影响观察[J].实用手外科杂志,2025,39(03):360-362. [21] 张永帅,王统正.锚钉韧带修复踝关节骨折合并下胫腓联合损伤的疗效及功能恢复分析[J].实用手外科杂志,2025,39(03):346-351. [22] Falk I S S,Mittlmeier T.Should we consider ankle fractures as osteoporotic fractures?[J].Osteoporosis International,2025,(prepublish):1-6. [23] Miksch C R,Spindler T F,Böcker W,et al.Arthroscopically assisted(AORIF)ankle fracture treatment seems to lead to superior results when compared to open reduction and internal fixation(ORIF)only:results of a systematic review.[J].Archives of orthopaedic and trauma surgery,2025,145(1):451. [24] Kim K B,Flowers A,Kim K R,et al.Soft Tissue Outcomes of Timing for Surgical Intervention of Ankle Fractures.[J].Foot&ankle specialist,2025,19386400251374960. [25] Hu X,Wang X,Ji L,et al.[Early internal fixation combined with free anterolateral thigh perforator flap transplantation to treat open ankle fracture-dislocation].[J].Zhongguo xiu fu chong jian wai ke za zhi=Zhongguo xiufu chongjian waike zazhi=Chinese journal of reparative and reconstructive surgery,2025,39(9):1175-1179. [26] Attia K A,Urdahl H T,Dock C C,et al.Outcomes of Deltoid Ligament Repair in Surgically Treated Weber C Ankle Fractures With Deltoid Injury:A Retrospective Comparative Study.[J].Foot&ankle international,2025,10711007251361122. [27] Liu G,Sun Z,Yang M,et al.An overview on the management of ankle fractures in elderly patients aged 65 and over:a scoping review[J].European Journal of Orthopaedic Surgery&Traumatology,2025,35(1):396-396. [28] Chen P,Heinz N,Ng N,et al.Mechanical failure after primary internal fixation of unstable ankle fractures-A retrospective observational study.[J].Foot and ankle surgery:official journal of the European Society of Foot and Ankle Surgeons,2025. [29] MacFarlane M E,Qureshi A,Boggiano J V,et al.Arthroscopic assisted fixation of posterior malleolus fractures:Technical pearls and clinical outcomes.[J].Foot and ankle surgery:official journal of the European Society of Foot and Ankle Surgeons,2025. [30] Giordano V,Souza D S F,Rivas R D,et al.Tibiotalocalcaneal arthrodesis for failed osteosynthesis of the ankle joint using a retrograde femoral intramedullary nail:a retrospective observational study[J].Indian Journal of Orthopaedics,2025,(prepublish):1-13.

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