Sun Yiyuan, Xiao Dan, Fu Weili, Cai Wufeng, Huang Xihao, Li Qi, Li Jian
Day Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, China.
Yong Chuan Hospital of ChongQing Medical University, Chongqing 402160, China.
J Clin Med. 2022 Nov 22;11(23):6886. doi: 10.3390/jcm11236886.
Visual clarity during shoulder arthroscopy can ensure an efficient and effective performance of the procedure, and it is highly related to bleeding without a tourniquet. Tranexamic acid (TXA) is widely used in adult reconstruction procedures; however, its use in shoulder arthroscopic operations is a relatively novel topic.
To analyze the available literature on visual clarity, blood loss, pain control, functional outcomes, and complications after the administration of tranexamic acid in shoulder arthroscopic surgery.
A literature search was performed to retrieve randomized controlled trials examining the use of tranexamic acid at the time of shoulder arthroscopic surgery. The literature search included the MEDLINE, Embase, Web of Science, and Cochrane Library databases. The primary outcomes included visual clarity, blood loss, and visual analog scale scores for pain. Secondary outcomes were operative time, irrigation amount used, postoperative shoulder swelling, the need for pressure increase, mean arterial pressure (MAP), functional outcomes, postoperative adverse effects such as deep venous thrombosis, and pulmonary embolism. The outcomes were pooled to perform a meta-analysis.
Seven prospective randomized controlled trials met the inclusion criteria for analysis. All of the included studies performed arthroscopic rotator cuff repair. No significant difference in visual clarity was observed (SMD (standardized mean difference), 0.45 [95% CI(confidence interval), -0.68, 1.59]; = 0.44) nor in pain score (MD (mean difference), -0.46 [95% CI, -0.97, 0.05]; = 0.08) between the TXA group and the control group. Two studies found no significant difference in blood loss between the TXA group and the control group. The meta-analysis from five studies demonstrated no significant difference between the TXA and control groups in operative time (MD, -3.51 [95% CI, -15.82, 8.80]; = 0.58) or irrigation amount used (MD, -2.53 [95% CI, -5.93, 0.87]; = 0.14). Two trials reported different statistical results in postoperative shoulder swelling. No significant differences regarding the need for pressure increase and MAP were reported between groups. No wound complications or infections or cardiac, thrombotic, or thromboembolic complications were recorded in either group.
The use of intravenous or local TXA in shoulder arthroscopic surgery did not increase complications or thromboembolic events, but TXA had no obviously effect of reducing bleeding to obtain a clear visual field or pain release in patients undergoing shoulder arthroscopic surgery.
肩关节镜检查期间的视野清晰度可确保手术高效进行，且与无止血带情况下的出血密切相关。氨甲环酸（TXA）广泛应用于成人重建手术；然而，其在肩关节镜手术中的应用是一个相对较新的话题。
分析关于氨甲环酸在肩关节镜手术中应用后的视野清晰度、失血情况、疼痛控制、功能结局及并发症的现有文献。
进行文献检索以获取考察肩关节镜手术时氨甲环酸应用情况的随机对照试验。文献检索包括MEDLINE、Embase、科学引文索引和考克兰图书馆数据库。主要结局包括视野清晰度、失血情况及疼痛视觉模拟评分。次要结局为手术时间、冲洗液用量、术后肩部肿胀情况、增加压力的必要性、平均动脉压（MAP）、功能结局、术后不良反应如深静脉血栓形成和肺栓塞。对结局进行汇总以进行荟萃分析。
七项前瞻性随机对照试验符合纳入分析的标准。所有纳入研究均进行了关节镜下肩袖修复术。TXA组与对照组在视野清晰度方面未观察到显著差异（标准化均数差（SMD），0.45 [95%置信区间（CI），-0.68，1.59]；P = 0.44），在疼痛评分方面也未观察到显著差异（均数差（MD），-0.46 [95% CI，-0.97，0.05]；P = 0.08）。两项研究发现TXA组与对照组在失血情况上无显著差异。五项研究的荟萃分析表明，TXA组与对照组在手术时间（MD，-3.51 [95% CI，-15.82，8.80]；P = 0.58）或冲洗液用量（MD，-2.53 [95% CI，-5.93，0.87]；P = 0.14）方面无显著差异。两项试验报告了术后肩部肿胀不同的统计结果。两组之间在增加压力的必要性和MAP方面未报告有显著差异。两组均未记录到伤口并发症、感染或心脏、血栓形成或血栓栓塞并发症。
在肩关节镜手术中使用静脉或局部TXA并未增加并发症或血栓栓塞事件，但TXA在接受肩关节镜手术的患者中对于获得清晰视野或减轻疼痛并无明显的减少出血作用。
