Orthopaedic Clinic, Department of Surgical Sciences, Policlinico San Martino IST, Genoa, Italy.
Orthopedic and Traumatology Unit 2, Santa Corona Hospital, Pietra Ligure, Italy.
Arthroscopy. 2019 Jan;35(1):149-157. doi: 10.1016/j.arthro.2018.07.050.
To evaluate the effect of tranexamic acid (TXA) in patients undergoing anterior cruciate ligament (ACL) reconstruction in reducing intra-articular effusion and affecting clinical outcomes 3 months after surgery.
Eighty consecutive patients undergoing ACL reconstruction were prospectively assessed from 2014 to 2016. Patients were randomly allocated to 1 of 2 groups: The test group received an intravenous infusion of 15 mg/kg of TXA, and the control group did not receive TXA. The patellar circumference, range of motion (ROM), Coupens and Yates (CY) value, visual analog scale score for pain assessment, and quadriceps strength (QS) were considered on postoperative day (PD) 1, PD 7, and PD 15 and at 1 month and 3 months after surgery. Blood volume in the intra-articular drainage was recorded on PD 1. Any adverse effect, such as fever onset (>37.5°C), hemarthrosis, or infection, was also considered.
We found a statistically significant reduction in drainage blood volume (P < .001) and CY value (P = .0044) on PD 1 in patients in the test group compared with those in the control group. On PD 7, a significant improvement was found for mean CY values (P = .0057), ROM (P = .0031), and QS (P = .015). On PD 15, we noted significant improvements in CY values (P < .001), patellar circumference (P = .0019), QS (P = .0089), and visual analog scale values (P = .0032) in the test group. We noted 13 fever episodes in the control group and 2 fever episodes in the study group (P = .047). No differences for any outcomes or complications were found at 3 months.
TXA administration reduced hemarthrosis and the amount of suction drainage blood volume, improved ROM and QS, and reduced fever episodes during the first 2 weeks after surgery. TXA use improved early-phase outcomes in the postoperative period after ACL reconstruction.
Level I, randomized controlled trial.
评估氨甲环酸（TXA）在接受前交叉韧带（ACL）重建的患者中减少关节内积液和影响术后 3 个月临床结果的效果。
2014 年至 2016 年，前瞻性评估了 80 例连续接受 ACL 重建的患者。患者随机分为 2 组：实验组给予 15mg/kg 的 TXA 静脉输注，对照组未给予 TXA。术后第 1、7、15 天及第 1、3 个月评估髌骨周径、关节活动度（ROM）、Coupens 和 Yates（CY）值、疼痛视觉模拟评分和股四头肌力量（QS）。记录术后第 1 天关节内引流的血容量。还考虑了任何不良影响，如发热（>37.5°C）、关节积血或感染。
与对照组相比，实验组患者术后第 1 天关节内引流血容量（P<0.001）和 CY 值（P=0.0044）显著降低。第 7 天，平均 CY 值（P=0.0057）、ROM（P=0.0031）和 QS（P=0.015）显著改善。第 15 天，实验组 CY 值（P<0.001）、髌骨周径（P=0.0019）、QS（P=0.0089）和视觉模拟评分（P=0.0032）均显著改善。对照组出现 13 例发热，研究组出现 2 例发热（P=0.047）。3 个月时，两组在任何结果或并发症方面均无差异。
TXA 给药减少了关节积血和引流血容量，改善了 ROM 和 QS，并减少了术后前 2 周的发热次数。TXA 的使用改善了 ACL 重建术后的早期术后结果。
I 级，随机对照试验。
