背景:氨甲环酸(TXA)可降低开放性肘关节松解术中的出血和血肿发生率。然而,其对关节镜下肘关节松解术的影响尚不清楚。这项研究旨在评估TXA对肘关节镜手术的影响,并比较出血量,关节积血,疼痛的视觉模拟量表(VAS),运动范围(ROM),术后早期接受关节内TXA和未接受关节内TXA的患者之间的Mayo肘关节性能评分(MEPS)。
方法:前瞻性,双盲,在2021年1月至2022年12月期间,我们进行了80例接受关节镜下关节松解术的肘部僵硬患者的随机对照试验.关节内,根据随机分组,关节镜手术后给予100ml盐水或安慰剂(对照组)中的1gTXA。记录并比较各组参数,包括引流的出血量,血红蛋白(Hgb)水平,手术侧与对侧的手臂和前臂周长的比率,血肿分级,VAS,术后一周内ROM和MEPS。在一年的随访中,记录ROM和MEPS。
结果:参加本研究的所有患者在术后一周表现出ROM(屈伸)和MEPS的显着改善,两组之间没有显着差异。与对照组相比,TXA组引流出血量差异有统计学意义(61.45±47.7ml与89.8±47.0ml,p=0.030)和术后24小时更高的Hgb水平(13.5±1.5g/dLvs.12.6±1.8g/dLp=0.049)。而TXA组术后24小时手臂和前臂周度的比值与术前相比明显增加(1.05±0.06vs.1.02±0.04和1.02±0.06vs.0.98±0.04,分别为p=0.019和p=0.005),这种差异在术后一周的臂围比率消失。然而,对于前臂周长的比率(1.02±0.07vs.0.98±0.04,p=0.003)。此外,MEPS没有显着差异,术后1周两组间VAS或ROM。
结论:肘部僵硬的患者接受关节镜下关节松解术后很早就取得了令人满意的临床结果。与对照组相比,接受关节镜下肘关节松解术并关节内给予TXA的患者术后引流出血量明显减少,Hgb水平略高.术后一周,与TXA组相比,对照组上臂区域的肿胀稍多。这些发现表明,关节镜下松解术后关节内注射TXA治疗肘关节僵硬可在统计学上减少与术后出血相关的并发症。然而,它的临床相关性需要进一步研究。
BACKGROUND: Tranexamic acid (TXA) reduces bleeding and hematoma rates in open elbow arthrolysis. However, its effects on arthroscopic elbow arthrolysis remain unclear. This
study aims to evaluate the effect of TXA on elbow arthroscopic procedures and compare bleeding volume, hemarthrosis, visual analog scale (VAS) for pain, range of motion (ROM), and Mayo Elbow Performance Score (MEPS) in the early postoperative period between patients who received intra-articular TXA and those who did not.
METHODS: A prospective, double-blind, randomized controlled
trial enrolling 80 patients with stiff elbows who underwent arthroscopic arthrolysis was performed from January 2021 to December 2022. Intra-articularly, 1 g of TXA in 100 ml of saline or placebo (control group) was administered after the arthroscopic operation according to randomization. Parameters were recorded and compared between the groups, including bleeding volume of drainage, hemoglobin (Hgb) level, ratio of arm and forearm circumference of the surgical side to the contralateral side, grading of hematoma, VAS, ROM and MEPS within one week postoperatively. And during one year follow-up, ROM and MEPS were recorded.
RESULTS: All patients enrolled in this
study demonstrated significant improvements in ROM (flexion-extension) and MEPS one week postoperatively, with no significant differences observed between the two groups. Compared to the control group, the TXA group exhibited significant differences in the bleeding volume of drainage (61.45±47.7 ml vs. 89.8±47.0 ml, p=0.030) and a higher Hgb level 24 hours postoperatively (13.5±1.5 g/dL vs. 12.6±1.8 g/dL p=0.049). While the ratio of arm and forearm circumferences significantly increased 24 hours postoperatively compared to preoperative values in TXA group (1.05±0.06 vs. 1.02±0.04 and 1.02±0.06 vs. 0.98±0.04, with p=0.019 and p=0.005, respectively), this difference vanished one week postoperatively for the ratio of arm circumference. However, it persisted for the ratio of forearm circumference (1.02±0.07 vs. 0.98±0.04, p=0.003). Furthermore, there was no significant difference in MEPS, VAS or ROM between the two groups one week postoperatively.
CONCLUSIONS: Patients with stiff elbows who underwent arthroscopic arthrolysis achieved satisfactory clinical outcomes very early postoperatively. Compared to the control group, patients who underwent arthroscopic elbow arthrolysis with intra-articular administration of TXA exhibited significantly less bleeding volume of drainage and slightly higher Hgb levels postoperatively. One week postoperatively, slightly more swelling in the upper arm region was noted in the control group compared to the TXA group. These findings suggest that the intra-articular injection of TXA after arthroscopic release for elbow stiffness may statistically reduce complications related to postoperative bleeding. However, it\'s clinical relevance needs further investigation.