Progress in application of medical absorbable haemostatic materials for haemostasis in orthopaedic surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Gang ,  ZENG Yi

Department of Orthopaedics, Institute of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

ZENG Yi, Email: zengyi51@scu.edu.cn

Keywords：

Medical absorbable hemostatic material; orthopaedic surgery; haemostatic mechanism; biocompatibility

DOI：

10.7507/1002-1892.202405068

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective The application progress of medical absorbable haemostatic material (MAHM) in hemostasis during orthoapedic surgery was reviewed, in order to provide reference for clinical hemostasis program. Methods The domestic and foreign literature on the application of MAHM for hemostasis in orthopedic surgery was extensively reviewed and summarized. Results According to biocompatibility, MAHM can be divided into oxidized cellulose/oxidized regenerated cellulose materials, chitosan and its derivatives materials, starch materials, collagen and gelatin materials, and fibrin glue materials, etc., which can effectively reduce blood loss when used in orthopedic surgery for hemostasis. Each hemostatic material has different coagulation mechanism and suitable population. Oxidized cellulose/oxidized regenerated cellulose, chitosan and its derivatives, starch hemostatic material mainly stops bleeding by stimulating blood vessel contraction and gathering blood cells, which is suitable for people with abnormal coagulation function. Collagen, gelatin and fibrin glue hemostatic materials mainly affect the physiological coagulation mechanism of the human body to stop bleeding, suitable for people with normal coagulation function. Conclusion Reasonable selection of MAHM can effectively reduce perioperative blood loss and reduce the risk of postoperative complications, but at present, single hemostatic material can not meet clinical needs, and a new composite hemostatic material with higher hemostatic efficiency needs to be developed.

Citation： WANG Gang, ZENG Yi. Progress in application of medical absorbable haemostatic materials for haemostasis in orthopaedic surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(11): 1421-1426. doi: 10.7507/1002-1892.202405068 Copy

1.	Liu X, Zhang X, Chen Y, et al. Hidden blood loss after total hip arthroplasty. J Arthroplasty, 2011, 26(7): 1100-1105.
2.	Smorgick Y, Baker KC, Bachison CC, et al. Hidden blood loss during posterior spine fusion surgery. Spine J, 2013, 13(8): 877-881.
3.	Yombi JC, Putineanu DC, Cornu O, et al. Low haemoglobin at admission is associated with mortality after hip fractures in elderly patients. Bone Joint J, 2019, 101-B(9): 1122-1128.
4.	Lasocki S, Krauspe R, von Heymann C, et al. PREPARE: the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery: a multicentre, observational study. Eur J Anaesthesiol, 2015, 32(3): 160-167.
5.	De la Garza Ramos R, Goodwin CR, Jain A, et al. Development of a Metastatic Spinal Tumor Frailty Index (MSTFI) using a nationwide database and its association with inpatient morbidity, mortality, and length of stay after spine surgery. World Neurosurg, 2016, 95: 548-555.
6.	Vochteloo AJ, Borger van der Burg BL, Mertens B, et al. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patients. BMC Musculoskelet Disord, 2011, 12: 262. doi: 10.1186/1471-2474-12-262.
7.	Smilowitz NR, Oberweis BS, Nukala S, et al. Association between anemia, bleeding, and transfusion with long-term mortality following noncardiac surgery. Am J Med, 2016, 129(3): 315-323.
8.	王華鋒, 劉恒旸, 王靜成. 骨科大手術圍手術期貧血狀況及血液管理. 中華創傷骨科雜志, 2012, 14(6): 532-535.
9.	Karcutskie CA, Namias N. Risk of infection and blood transfusion in trauma. Surg Infect (Larchmt), 2017, 18(6): 751. doi: 10.1089/sur.2017.079.
10.	胡鳴, 畢大鵬, 汪穎峰, 等. 醫用可吸收止血材料的臨床應用與研究進展. 足踝外科電子雜志, 2020, 7(3): 58-62.
11.	汪向飛, 張曉丹, 周漢新. 生物醫用可吸收止血材料的研究與臨床應用. 中國組織工程研究與臨床康復, 2010, 14(21): 3973-3976.
12.	Hu B, Bao G, Xu X, et al. Topical hemostatic materials for coagulopathy. J Mater Chem B, 2022, 10(12): 1946-1959.
13.	Zhang SH, Li JW, Chen SJ, et al. Oxidized cellulose-based hemostatic materials. Carbohydrate Polymers, 2020. doi: 10.1016/j.carbpol.2019.115585.
14.	李玉基, 史玉清. MAUDE數據庫中速即紗不良事件報告分析. 中國藥物警戒, 2013, 10(5): 312-314.
15.	Franceschini G. Internal surgical use of biodegradable carbohydrate polymers. Warning for a conscious and proper use of oxidized regenerated cellulose. Carbohydr Polym, 2019, 216: 213-216.
16.	Cheng W, He J, Wu Y, et al. Preparation and characterization of oxidized regenerated cellulose film for hemostasis and the effect of blood on its surface. Cellulose, 2013, 20(5): 2547-2558.
17.	Hutchinson RW, George K, Johns D, et al. Hemostatic efficacy and tissue reaction of oxidized regenerated cellulose hemostats. Cellulose, 2013, 20(1): 537-545.
18.	Tam T, Harkins G, Dykes T, et al. Oxidized regenerated cellulose resembling vaginal cuff abscess. JSLS, 2014, 18(2): 353-356.
19.	Rassu PC, Serventi A, Giaminardi E, et al. Use of oxidized and regenerated cellulose polymer in oncoplastic breast surgery. Ann Ital Chir, 2013, 84(ePub): S2239253X13020288.
20.	張爽, 徐慶華, 童琳, 等. 可吸收止血材料的研究現狀與應用. 中國組織工程研究, 2021, 25(10): 1628-1634.
21.	李偉, 王玲爽, 孫偉慶. 纖維素類止血材料的臨床應用及作用機制的研究. 當代醫藥論叢, 2019, 17(22): 13-15.
22.	Acheson EM, Kheirabadi BS, Deguzman R, et al. Comparison of hemorrhage control agents applied to lethal extremity arterial hemorrhages in swine. J Trauma, 2005, 59(4): 865-874.
23.	Yan T, Cheng F, Wei X, et al. Biodegradable collagen sponge reinforced with chitosan/calcium pyrophosphate nanoflowers for rapid hemostasis. Carbohydr Polym, 2017, 170: 271-280.
24.	Wang W, Meng Q, Li Q, et al. Chitosan derivatives and their application in biomedicine. Int J Mol Sci, 2020, 21(2): 487. doi: 10.3390/ijms21020487.
25.	Liu S, Huang X, Fu C, et al. Is it an outbreak of health care-associated infection? An investigation of binocular conjunctival congestion after laparoscopic cholecystectomy was traced to chitosan derivatives. Front Med (Lausanne), 2022, 9: 759945. doi: 10.3389/fmed.2022.759945.
26.	Chen KY, Lin TH, Yang CY, et al. Mechanics for the adhesion and aggregation of red blood cells on chitosan. Journal of Mechanics, 2018, 34(5): 725-732.
27.	Khan MA, Mujahid M. A review on recent advances in chitosan based composite for hemostatic dressings. Int J Biol Macromol, 2019, 124: 138-147.
28.	Varaprasad Bobbarala. Concepts, Compounds and the Alternatives of Antibacterials//Ibrahim HM, Zairy EMRE. Chitosan as a biomaterial—structure, properties, and electrospun nanofibers. InTech, 2015. http://dx. doi.org/10.5772/61300.
29.	Shen EC, Chou TC, Gau CH, et al. Releasing growth factors from activated human platelets after chitosan stimulation: a possible bio-material for platelet-rich plasma preparation. Clin Oral Implants Res, 2006, 17(5): 572-578.
30.	任康, 吳瀝豪, 許零. 羧甲基殼聚糖基止血材料及其止血機制的研究進展. 中國實驗血液學雜志, 2023, 31(3): 911-915.
31.	Lewis KM, Atlee H, Mannone A, et al. Efficacy of hemostatic matrix and microporous polysaccharide hemospheres. J Surg Res, 2015, 193(2): 825-830.
32.	Burks S, Spotnitz W. Safety and usability of hemostats, sealants, and adhesives. AORN J, 2014, 100(2): 160-176.
33.	Ko YG, Kim BN, Kim EJ, et al. Bioabsorbable carboxymethyl starch-calcium ionic assembly powder as a hemostatic agent. Polymers (Basel), 2022, 14(18): 3909. doi: 10.3390/polym14183909.
34.	Pusateri AE, Modrow HE, Harris RA, et al. Advanced hemostatic dressing development program: animal model selection criteria and results of a study of nine hemostatic dressings in a model of severe large venous hemorrhage and hepatic injury in Swine. J Trauma, 2003, 55(3): 518-526.
35.	林振華, 侯麗, 董傳俊, 等. 膠原蛋白止血海綿在豬肝臟出血模型中止血效果研究. 中國醫療設備, 2018, 33(11): 7-9.
36.	鄭江, 李開南, 陳爾東, 等. 可即邦醫用膠原蛋白海綿在脛骨骨折中的應用觀察. 中文科技期刊數據庫 (全文版) 醫藥衛生, 2023, (1): 49-52.
37.	Apel-Sarid L, Cochrane DD, Steinbok P, et al. Microfibrillar collagen hemostat-induced necrotizing granulomatous inflammation developing after craniotomy: a pediatric case series. J Neurosurg Pediatr, 2010, 6(4): 385-392.
38.	Manon-Jensen T, Kjeld NG, Karsdal MA. Collagen-mediated hemostasis. J Thromb Haemost, 2016, 14(3): 438-448.
39.	Farndale RW, Sixma JJ, Barnes MJ, et al. The role of collagen in thrombosis and hemostasis. J Thromb Haemost, 2004, 2(4): 561-573.
40.	楊立宇, 王星力, 周隆, 等. 纖維蛋白黏合劑對全膝關節置換后止血效果的影響. 中國組織工程研究, 2013, 17(13): 2399-2406.
41.	李清正, 馮力更, 羅永康. 復合肌原纖維蛋白的凝膠特性. 肉類研究, 2016, 30(12): 6.
42.	姚晨, 孫玉強. 殼聚糖基可吸收止血非織布在髖關節置換術中應用的止血效果觀察. 中國骨與關節損傷雜志, 2021, 36(6): 600-602.
43.	趙志虎, 孫曉雷, 馬劍雄, 等. 局部應用纖維蛋白膠對全髖關節置換術止血效果有效性和安全性的Meta分析. 中華創傷雜志, 2016, 32(3): 223-228.
44.	Li B, Pan W, Sun X, et al. Hemostatic effect and safety evaluation of oxidized regenerated cellulose in total knee arthroplasty-a randomized controlledtrial. BMC Musculoskelet Disord, 2023, 24(1): 797. doi: 10.1186/s12891-023-06932-7.
45.	繆國忠. 中國兒童青少年脊柱側凸篩查方法與患病率調查研究. 疾病預防控制通報, 2016, 31(1): 11-14, 27.
46.	Ma L, Dai L, Yang Y, et al. Comparison the efficacy of hemorrhage control of Surgiflo Haemostatic Matrix and absorbable gelatin sponge in posterior lumbar surgery: A randomized controlled study. Medicine (Baltimore), 2018, 97(49): e13511. doi: 10.1097/MD.0000000000013511.
47.	李廣州, 洪瑛, 劉浩, 等. 兩種止血材料在頸椎單開門椎管擴大成形術中的止血效果觀察. 中國骨傷, 2017, 30(9): 849-852.
48.	Ramirez MG, Deutsch H, Khanna N, et al. Floseal only versus in combination in spine surgery: a comparative, retrospective hospital database evaluation of clinical and healthcare resource outcomes. Hosp Pract (1995), 2018, 46(4): 189-196.
49.	李楠, 劉波, 何達, 等. 氧化再生纖維素和可吸收明膠海綿在ACDF術中的止血作用對比. 山東醫藥, 2014, 54(44): 34-36.
50.	李勇. 可吸收止血微球在四肢骨折內固定術中的臨床應用. 中國現代醫學雜志, 2014, 24(10): 89-91.
51.	徐詣, 丑克, 何志勇, 等. 可吸收性止血材料在鎖骨骨折內固定術的應用. 中國矯形外科雜志, 2016, 24(24): 2294-2296.

1. Liu X, Zhang X, Chen Y, et al. Hidden blood loss after total hip arthroplasty. J Arthroplasty, 2011, 26(7): 1100-1105.
2. Smorgick Y, Baker KC, Bachison CC, et al. Hidden blood loss during posterior spine fusion surgery. Spine J, 2013, 13(8): 877-881.
3. Yombi JC, Putineanu DC, Cornu O, et al. Low haemoglobin at admission is associated with mortality after hip fractures in elderly patients. Bone Joint J, 2019, 101-B(9): 1122-1128.
4. Lasocki S, Krauspe R, von Heymann C, et al. PREPARE: the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery: a multicentre, observational study. Eur J Anaesthesiol, 2015, 32(3): 160-167.
5. De la Garza Ramos R, Goodwin CR, Jain A, et al. Development of a Metastatic Spinal Tumor Frailty Index (MSTFI) using a nationwide database and its association with inpatient morbidity, mortality, and length of stay after spine surgery. World Neurosurg, 2016, 95: 548-555.
6. Vochteloo AJ, Borger van der Burg BL, Mertens B, et al. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patients. BMC Musculoskelet Disord, 2011, 12: 262. doi: 10.1186/1471-2474-12-262.
7. Smilowitz NR, Oberweis BS, Nukala S, et al. Association between anemia, bleeding, and transfusion with long-term mortality following noncardiac surgery. Am J Med, 2016, 129(3): 315-323.
8. 王華鋒, 劉恒旸, 王靜成. 骨科大手術圍手術期貧血狀況及血液管理. 中華創傷骨科雜志, 2012, 14(6): 532-535.
9. Karcutskie CA, Namias N. Risk of infection and blood transfusion in trauma. Surg Infect (Larchmt), 2017, 18(6): 751. doi: 10.1089/sur.2017.079.
10. 胡鳴, 畢大鵬, 汪穎峰, 等. 醫用可吸收止血材料的臨床應用與研究進展. 足踝外科電子雜志, 2020, 7(3): 58-62.
11. 汪向飛, 張曉丹, 周漢新. 生物醫用可吸收止血材料的研究與臨床應用. 中國組織工程研究與臨床康復, 2010, 14(21): 3973-3976.
12. Hu B, Bao G, Xu X, et al. Topical hemostatic materials for coagulopathy. J Mater Chem B, 2022, 10(12): 1946-1959.
13. Zhang SH, Li JW, Chen SJ, et al. Oxidized cellulose-based hemostatic materials. Carbohydrate Polymers, 2020. doi: 10.1016/j.carbpol.2019.115585.
14. 李玉基, 史玉清. MAUDE數據庫中速即紗不良事件報告分析. 中國藥物警戒, 2013, 10(5): 312-314.
15. Franceschini G. Internal surgical use of biodegradable carbohydrate polymers. Warning for a conscious and proper use of oxidized regenerated cellulose. Carbohydr Polym, 2019, 216: 213-216.
16. Cheng W, He J, Wu Y, et al. Preparation and characterization of oxidized regenerated cellulose film for hemostasis and the effect of blood on its surface. Cellulose, 2013, 20(5): 2547-2558.
17. Hutchinson RW, George K, Johns D, et al. Hemostatic efficacy and tissue reaction of oxidized regenerated cellulose hemostats. Cellulose, 2013, 20(1): 537-545.
18. Tam T, Harkins G, Dykes T, et al. Oxidized regenerated cellulose resembling vaginal cuff abscess. JSLS, 2014, 18(2): 353-356.
19. Rassu PC, Serventi A, Giaminardi E, et al. Use of oxidized and regenerated cellulose polymer in oncoplastic breast surgery. Ann Ital Chir, 2013, 84(ePub): S2239253X13020288.
20. 張爽, 徐慶華, 童琳, 等. 可吸收止血材料的研究現狀與應用. 中國組織工程研究, 2021, 25(10): 1628-1634.
21. 李偉, 王玲爽, 孫偉慶. 纖維素類止血材料的臨床應用及作用機制的研究. 當代醫藥論叢, 2019, 17(22): 13-15.
22. Acheson EM, Kheirabadi BS, Deguzman R, et al. Comparison of hemorrhage control agents applied to lethal extremity arterial hemorrhages in swine. J Trauma, 2005, 59(4): 865-874.
23. Yan T, Cheng F, Wei X, et al. Biodegradable collagen sponge reinforced with chitosan/calcium pyrophosphate nanoflowers for rapid hemostasis. Carbohydr Polym, 2017, 170: 271-280.
24. Wang W, Meng Q, Li Q, et al. Chitosan derivatives and their application in biomedicine. Int J Mol Sci, 2020, 21(2): 487. doi: 10.3390/ijms21020487.
25. Liu S, Huang X, Fu C, et al. Is it an outbreak of health care-associated infection? An investigation of binocular conjunctival congestion after laparoscopic cholecystectomy was traced to chitosan derivatives. Front Med (Lausanne), 2022, 9: 759945. doi: 10.3389/fmed.2022.759945.
26. Chen KY, Lin TH, Yang CY, et al. Mechanics for the adhesion and aggregation of red blood cells on chitosan. Journal of Mechanics, 2018, 34(5): 725-732.
27. Khan MA, Mujahid M. A review on recent advances in chitosan based composite for hemostatic dressings. Int J Biol Macromol, 2019, 124: 138-147.
28. Varaprasad Bobbarala. Concepts, Compounds and the Alternatives of Antibacterials//Ibrahim HM, Zairy EMRE. Chitosan as a biomaterial—structure, properties, and electrospun nanofibers. InTech, 2015. http://dx. doi.org/10.5772/61300.
29. Shen EC, Chou TC, Gau CH, et al. Releasing growth factors from activated human platelets after chitosan stimulation: a possible bio-material for platelet-rich plasma preparation. Clin Oral Implants Res, 2006, 17(5): 572-578.
30. 任康, 吳瀝豪, 許零. 羧甲基殼聚糖基止血材料及其止血機制的研究進展. 中國實驗血液學雜志, 2023, 31(3): 911-915.
31. Lewis KM, Atlee H, Mannone A, et al. Efficacy of hemostatic matrix and microporous polysaccharide hemospheres. J Surg Res, 2015, 193(2): 825-830.
32. Burks S, Spotnitz W. Safety and usability of hemostats, sealants, and adhesives. AORN J, 2014, 100(2): 160-176.
33. Ko YG, Kim BN, Kim EJ, et al. Bioabsorbable carboxymethyl starch-calcium ionic assembly powder as a hemostatic agent. Polymers (Basel), 2022, 14(18): 3909. doi: 10.3390/polym14183909.
34. Pusateri AE, Modrow HE, Harris RA, et al. Advanced hemostatic dressing development program: animal model selection criteria and results of a study of nine hemostatic dressings in a model of severe large venous hemorrhage and hepatic injury in Swine. J Trauma, 2003, 55(3): 518-526.
35. 林振華, 侯麗, 董傳俊, 等. 膠原蛋白止血海綿在豬肝臟出血模型中止血效果研究. 中國醫療設備, 2018, 33(11): 7-9.
36. 鄭江, 李開南, 陳爾東, 等. 可即邦醫用膠原蛋白海綿在脛骨骨折中的應用觀察. 中文科技期刊數據庫 (全文版) 醫藥衛生, 2023, (1): 49-52.
37. Apel-Sarid L, Cochrane DD, Steinbok P, et al. Microfibrillar collagen hemostat-induced necrotizing granulomatous inflammation developing after craniotomy: a pediatric case series. J Neurosurg Pediatr, 2010, 6(4): 385-392.
38. Manon-Jensen T, Kjeld NG, Karsdal MA. Collagen-mediated hemostasis. J Thromb Haemost, 2016, 14(3): 438-448.
39. Farndale RW, Sixma JJ, Barnes MJ, et al. The role of collagen in thrombosis and hemostasis. J Thromb Haemost, 2004, 2(4): 561-573.
40. 楊立宇, 王星力, 周隆, 等. 纖維蛋白黏合劑對全膝關節置換后止血效果的影響. 中國組織工程研究, 2013, 17(13): 2399-2406.
41. 李清正, 馮力更, 羅永康. 復合肌原纖維蛋白的凝膠特性. 肉類研究, 2016, 30(12): 6.
42. 姚晨, 孫玉強. 殼聚糖基可吸收止血非織布在髖關節置換術中應用的止血效果觀察. 中國骨與關節損傷雜志, 2021, 36(6): 600-602.
43. 趙志虎, 孫曉雷, 馬劍雄, 等. 局部應用纖維蛋白膠對全髖關節置換術止血效果有效性和安全性的Meta分析. 中華創傷雜志, 2016, 32(3): 223-228.
44. Li B, Pan W, Sun X, et al. Hemostatic effect and safety evaluation of oxidized regenerated cellulose in total knee arthroplasty-a randomized controlledtrial. BMC Musculoskelet Disord, 2023, 24(1): 797. doi: 10.1186/s12891-023-06932-7.
45. 繆國忠. 中國兒童青少年脊柱側凸篩查方法與患病率調查研究. 疾病預防控制通報, 2016, 31(1): 11-14, 27.
46. Ma L, Dai L, Yang Y, et al. Comparison the efficacy of hemorrhage control of Surgiflo Haemostatic Matrix and absorbable gelatin sponge in posterior lumbar surgery: A randomized controlled study. Medicine (Baltimore), 2018, 97(49): e13511. doi: 10.1097/MD.0000000000013511.
47. 李廣州, 洪瑛, 劉浩, 等. 兩種止血材料在頸椎單開門椎管擴大成形術中的止血效果觀察. 中國骨傷, 2017, 30(9): 849-852.
48. Ramirez MG, Deutsch H, Khanna N, et al. Floseal only versus in combination in spine surgery: a comparative, retrospective hospital database evaluation of clinical and healthcare resource outcomes. Hosp Pract (1995), 2018, 46(4): 189-196.
49. 李楠, 劉波, 何達, 等. 氧化再生纖維素和可吸收明膠海綿在ACDF術中的止血作用對比. 山東醫藥, 2014, 54(44): 34-36.
50. 李勇. 可吸收止血微球在四肢骨折內固定術中的臨床應用. 中國現代醫學雜志, 2014, 24(10): 89-91.
51. 徐詣, 丑克, 何志勇, 等. 可吸收性止血材料在鎖骨骨折內固定術的應用. 中國矯形外科雜志, 2016, 24(24): 2294-2296.

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Progress in application of medical absorbable haemostatic materials for haemostasis in orthopaedic surgery

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