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.	王华锋, 刘恒旸, 王静成. 骨科大手术围手术期贫血状况及血液管理. 中华创伤骨科杂志, 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.	胡鸣, 毕大鹏, 汪颖峰, 等. 医用可吸收止血材料的临床应用与研究进展. 足踝外科电子杂志, 2020, 7(3): 58-62.
11.	汪向飞, 张晓丹, 周汉新. 生物医用可吸收止血材料的研究与临床应用. 中国组织工程研究与临床康复, 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数据库中速即纱不良事件报告分析. 中国药物警戒, 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.	张爽, 徐庆华, 童琳, 等. 可吸收止血材料的研究现状与应用. 中国组织工程研究, 2021, 25(10): 1628-1634.
21.	李伟, 王玲爽, 孙伟庆. 纤维素类止血材料的临床应用及作用机制的研究. 当代医药论丛, 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, 吴沥豪, 许零. 羧甲基壳聚糖基止血材料及其止血机制的研究进展. 中国实验血液学杂志, 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.	林振华, 侯丽, 董传俊, 等. 胶原蛋白止血海绵在猪肝脏出血模型中止血效果研究. 中国医疗设备, 2018, 33(11): 7-9.
36.	郑江, 李开南, 陈尔东, 等. 可即邦医用胶原蛋白海绵在胫骨骨折中的应用观察. 中文科技期刊数据库 (全文版) 医药卫生, 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.	杨立宇, 王星力, 周隆, 等. 纤维蛋白黏合剂对全膝关节置换后止血效果的影响. 中国组织工程研究, 2013, 17(13): 2399-2406.
41.	李清正, 冯力更, 罗永康. 复合肌原纤维蛋白的凝胶特性. 肉类研究, 2016, 30(12): 6.
42.	姚晨, 孙玉强. 壳聚糖基可吸收止血非织布在髋关节置换术中应用的止血效果观察. 中国骨与关节损伤杂志, 2021, 36(6): 600-602.
43.	赵志虎, 孙晓雷, 马剑雄, 等. 局部应用纤维蛋白胶对全髋关节置换术止血效果有效性和安全性的Meta分析. 中华创伤杂志, 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.	缪国忠. 中国儿童青少年脊柱侧凸筛查方法与患病率调查研究. 疾病预防控制通报, 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.	李广州, 洪瑛, 刘浩, 等. 两种止血材料在颈椎单开门椎管扩大成形术中的止血效果观察. 中国骨伤, 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, 刘波, 何达, 等. 氧化再生纤维素和可吸收明胶海绵在ACDF术中的止血作用对比. 山东医药, 2014, 54(44): 34-36.
50.	李勇. 可吸收止血微球在四肢骨折内固定术中的临床应用. 中国现代医学杂志, 2014, 24(10): 89-91.
51.	徐诣, 丑克, 何志勇, 等. 可吸收性止血材料在锁骨骨折内固定术的应用. 中国矫形外科杂志, 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. 王华锋, 刘恒旸, 王静成. 骨科大手术围手术期贫血状况及血液管理. 中华创伤骨科杂志, 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. 胡鸣, 毕大鹏, 汪颖峰, 等. 医用可吸收止血材料的临床应用与研究进展. 足踝外科电子杂志, 2020, 7(3): 58-62.
11. 汪向飞, 张晓丹, 周汉新. 生物医用可吸收止血材料的研究与临床应用. 中国组织工程研究与临床康复, 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数据库中速即纱不良事件报告分析. 中国药物警戒, 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. 张爽, 徐庆华, 童琳, 等. 可吸收止血材料的研究现状与应用. 中国组织工程研究, 2021, 25(10): 1628-1634.
21. 李伟, 王玲爽, 孙伟庆. 纤维素类止血材料的临床应用及作用机制的研究. 当代医药论丛, 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, 吴沥豪, 许零. 羧甲基壳聚糖基止血材料及其止血机制的研究进展. 中国实验血液学杂志, 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. 林振华, 侯丽, 董传俊, 等. 胶原蛋白止血海绵在猪肝脏出血模型中止血效果研究. 中国医疗设备, 2018, 33(11): 7-9.
36. 郑江, 李开南, 陈尔东, 等. 可即邦医用胶原蛋白海绵在胫骨骨折中的应用观察. 中文科技期刊数据库 (全文版) 医药卫生, 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. 杨立宇, 王星力, 周隆, 等. 纤维蛋白黏合剂对全膝关节置换后止血效果的影响. 中国组织工程研究, 2013, 17(13): 2399-2406.
41. 李清正, 冯力更, 罗永康. 复合肌原纤维蛋白的凝胶特性. 肉类研究, 2016, 30(12): 6.
42. 姚晨, 孙玉强. 壳聚糖基可吸收止血非织布在髋关节置换术中应用的止血效果观察. 中国骨与关节损伤杂志, 2021, 36(6): 600-602.
43. 赵志虎, 孙晓雷, 马剑雄, 等. 局部应用纤维蛋白胶对全髋关节置换术止血效果有效性和安全性的Meta分析. 中华创伤杂志, 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. 缪国忠. 中国儿童青少年脊柱侧凸筛查方法与患病率调查研究. 疾病预防控制通报, 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. 李广州, 洪瑛, 刘浩, 等. 两种止血材料在颈椎单开门椎管扩大成形术中的止血效果观察. 中国骨伤, 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, 刘波, 何达, 等. 氧化再生纤维素和可吸收明胶海绵在ACDF术中的止血作用对比. 山东医药, 2014, 54(44): 34-36.
50. 李勇. 可吸收止血微球在四肢骨折内固定术中的临床应用. 中国现代医学杂志, 2014, 24(10): 89-91.
51. 徐诣, 丑克, 何志勇, 等. 可吸收性止血材料在锁骨骨折内固定术的应用. 中国矫形外科杂志, 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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