Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, P.R. China.
Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, P.R. China.
J Shoulder Elbow Surg. 2021 Aug;30(8):1725-1732. doi: 10.1016/j.jse.2021.04.031. Epub 2021 May 5.
Open elbow arthrolysis (OEA), which has become an established treatment for post-traumatic elbow stiffness (PTES), requires complete release of contracture tissue and wide excision of ectopic bone, which results in extensive bleeding. The aim of the present study is to evaluate the efficacy of intravenous tranexamic acid (TXA) on postoperative drainage, calculated blood loss, and early clinical outcomes in patients undergoing OEA.
A double-blind, randomized, placebo-controlled trial including 96 patients undergoing OEA was undertaken. Patients received intravenously either 100 mL saline (placebo group, n = 48), or 100 mL saline plus 1 g TXA (TXA group, n = 48) before skin incision. The primary outcome was the drainage volume on postoperative days (PODs) 1-3. Secondary outcomes included the calculated blood loss, elbow pain score measured by visual analog scale (VAS), elbow function valued by Mayo Elbow Performance Score (MEPS), and rate of complications after OEA.
Mean total postoperative drainage volume (TXA group: 182 mL vs. placebo group: 214 mL, P = .003) and mean calculated total blood loss (TXA group: 582 mL vs. placebo group: 657 mL, P = .004) were significantly lower in the TXA group. No transfusions were necessary in either group. Mean VAS pain scores in elbow motion showed marked differences between both groups on POD 1 (TXA: 5 vs. placebo: 6, P = .003) and POD 2 (TXA: 4 vs. placebo: 5, P = .023) but not in other postoperative time points. No differences were detected in complications, such as pin-related infection, hematoma, new or exacerbation of ulnar nerve symptoms, and recurrent heterotopic ossification. At the 6-month follow-up, no statistical differences were found between the 2 groups with respect to the elbow functions including range of motion, VAS score, and MEPS.
Intravenous administration of TXA significantly decreased the postoperative drainage volume and the total estimated blood loss and alleviated the elbow pain with motion during early postoperative days in patients undergoing OEA.
开放式肘松解术（OEA）已成为创伤后肘僵硬（PTES）的既定治疗方法，需要完全松解挛缩组织并广泛切除异位骨，从而导致大量出血。本研究旨在评估静脉注射氨甲环酸（TXA）对接受 OEA 的患者术后引流、计算失血量和早期临床结果的影响。
进行了一项双盲、随机、安慰剂对照试验，纳入了 96 例接受 OEA 的患者。患者在切开皮肤前分别静脉注射 100 mL 生理盐水（安慰剂组，n = 48）或 100 mL 生理盐水加 1 g TXA（TXA 组，n = 48）。主要结局是术后第 1-3 天的引流量。次要结局包括计算失血量、视觉模拟评分（VAS）测量的肘部疼痛评分、 Mayo 肘部功能评分（MEPS）评估的肘部功能以及 OEA 后的并发症发生率。
TXA 组的总术后引流量（TXA 组：182 mL vs. 安慰剂组：214 mL，P =.003）和总计算失血量（TXA 组：582 mL vs. 安慰剂组：657 mL，P =.004）均明显低于安慰剂组。两组均无需输血。在术后第 1 天（TXA：5 分 vs. 安慰剂：6 分，P =.003）和第 2 天（TXA：4 分 vs. 安慰剂：5 分，P =.023），TXA 组肘部活动时的 VAS 疼痛评分明显低于安慰剂组，但在其他术后时间点无差异。两组在并发症方面无差异，如针相关感染、血肿、尺神经症状新出现或加重以及异位骨化复发。在 6 个月随访时，两组在肘部功能（包括活动范围、VAS 评分和 MEPS）方面无统计学差异。
静脉注射 TXA 可显著减少 OEA 患者术后引流量和总估计失血量，并减轻术后早期肘部活动时的疼痛。
