Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan.
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan.
Arthroscopy. 2019 Jul;35(7):2127-2132. doi: 10.1016/j.arthro.2019.02.018. Epub 2019 Jun 18.
To evaluate the effect of intra-articular injection of tranexamic acid (TXA) in patients receiving arthroscopic anterior cruciate ligament reconstruction (ACLR).
A total of 304 patients were included in this study, which was performed between August 2017 and April 2018. Single-bundle reconstructions using autologous hamstring tendon grafts were performed in all patients. Patients were randomized into 2 groups: Group 1 patients (TXA group) received the index procedure with a 10-mL intra-articular injection of TXA (100 mg/mL). Group 2 patients (control group) received the index procedure without TXA injections. An intra-articular suction drain was placed in the joint and clamped for 2 hours after the procedure. The volume of drainage was recorded 24 hours after surgery. Clinical evaluations using the International Knee Documentation Committee functional score, range of motion, and a visual analog scale pain score were performed on day 3 and at week 4 postoperatively.
Twenty-four hours after surgery, a significant decrease in the amount of drainage was observed in patients receiving intra-articular injections (TXA group, 56.1 ± 34.1 mL; control group, 80.1 ± 48 mL; P < .05). On day 3 and at week 4, significantly reduced pain scores were reported in the TXA group. However, at week 4, clinical function scores did not show significant differences between the 2 groups.
Intra-articular injection of TXA could significantly reduce postoperative intra-articular bleeding in the first 24 hours in patients receiving arthroscopic ACLR. TXA injection may also decrease pain and the grade of hemarthrosis in the early postoperative period. No systemic side effects or need for aspiration was noted during the follow-up period. Therefore, intra-articular injection of TXA could be considered an effective and relatively safe solution to reduce postoperative bleeding and pain in ACLR patients.
Level II, prospective comparative study.
评估关节内注射氨甲环酸（TXA）对接受关节镜下前交叉韧带重建（ACLR）患者的影响。
本研究共纳入 304 例患者，研究时间为 2017 年 8 月至 2018 年 4 月。所有患者均采用自体腘绳肌腱进行单束重建。患者随机分为 2 组：TXA 组（TXA 组）在关节内注射 10mL 氨甲环酸（100mg/mL）；对照组（对照组）在关节内注射 TXA。手术后 2 小时夹闭关节内引流管。术后 24 小时记录引流体积。术后第 3 天和第 4 周分别采用国际膝关节文献委员会功能评分、关节活动度和视觉模拟评分进行临床评估。
术后 24 小时，关节内注射组患者的引流量明显减少（TXA 组：56.1±34.1mL；对照组：80.1±48mL；P<0.05）。在第 3 天和第 4 周，TXA 组患者的疼痛评分明显降低。然而，在第 4 周，两组的临床功能评分无显著差异。
关节内注射 TXA 可显著减少接受关节镜 ACLR 患者术后前 24 小时的关节内出血。TXA 注射还可能减轻术后早期的疼痛和关节积血量。在随访期间，未发现全身副作用或需要抽吸。因此，关节内注射 TXA 可作为减少 ACLR 患者术后出血和疼痛的有效且相对安全的方法。
II 级，前瞻性比较研究。
