Kawaguchi Shinji, Fukuta Shoji, Kano Masashi, Sairyo Koichi
Department of Orthopaedic Surgery, National Hospital Organization Kochi National Hospital, 1-2-25, Asakuranishimachi, Kochi, 780-8507, Japan.
Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2023 Feb 7;31:6-10. doi: 10.1016/j.asmart.2023.01.001. eCollection 2023 Jan.
Tranexamic acid (TXA) is widely used in hip and knee arthroplasty to reduce perioperative bleeding. Recently, its use has been expanded to arthroscopic surgery. The purpose of this study was to evaluate the efficacy of preoperative use of TXA in arthroscopic rotator cuff repair (RCR).
A cohort comprising 129 consecutive patients who underwent arthroscopic primary RCR at our institution was retrospectively investigated according to whether they received TXA (April 2018 to December 2020, TXA group, n = 64) or did not receive TXA (April 2016 to March 2018, non-TXA group, n = 65). TXA was administered at a dose of 1 g intravenously. Rotator cuff tears were repaired by the suture bridge technique. Videos of the arthroscopic procedures were reviewed and rated for visual clarity using a 10-point numeric rating scale. Arthroscopic procedures were divided into glenohumeral, resection of bursal tissue and acromioplasty, and RCR steps. Each step was rated separately. Age, sex, body mass index, hemoglobin level before and on days 1 and 7 after surgery, operating time, mean arterial pressure, tear size, and number of anchors used for cuff repair were compared between the two groups.
There were no statistically significant differences in the patient demographic data. The operating time was significantly shorter in the TXA group than in non-TXA group (97.8 ± 21.8 min vs 116.2 ± 26.0 min). The clarity of the visual field was similar between the two groups during the glenohumeral phase but was significantly higher in the TXA group during the resection of bursal tissue and acromioplasty and RCR phases. Hemoglobin level was not significantly different between the groups on postoperative day 1 but was significantly higher in the TXA group on day 7.
Administration of a single intravenous dose of TXA improved visual clarity in arthroscopic RCR, decreased the total operating time, and reduced hemoglobin loss on postoperative day 7.
氨甲环酸（TXA）广泛应用于髋关节和膝关节置换术以减少围手术期出血。最近，其应用已扩展至关节镜手术。本研究的目的是评估术前使用TXA在关节镜下肩袖修复术（RCR）中的疗效。
回顾性调查了在我院连续接受初次关节镜下RCR的129例患者，根据其是否接受TXA治疗分为两组（2018年4月至2020年12月，TXA组，n = 64；2016年4月至2018年3月，非TXA组，n = 65）。TXA静脉注射剂量为1 g。采用缝线桥技术修复肩袖撕裂。回顾关节镜手术视频，并使用10分数字评分量表对视觉清晰度进行评分。关节镜手术分为盂肱关节、滑囊组织切除和肩峰成形术以及RCR步骤。每个步骤分别评分。比较两组患者的年龄、性别、体重指数、术前及术后第1天和第7天的血红蛋白水平、手术时间、平均动脉压、撕裂大小以及用于肩袖修复的锚钉数量。
患者人口统计学数据无统计学显著差异。TXA组的手术时间显著短于非TXA组（97.8±21.8分钟 vs 116.2±26.0分钟）。在盂肱关节阶段，两组的视野清晰度相似，但在滑囊组织切除和肩峰成形术以及RCR阶段，TXA组的视野清晰度显著更高。两组术后第1天的血红蛋白水平无显著差异，但TXA组在第7天显著更高。
单次静脉注射TXA可提高关节镜下RCR的视觉清晰度，缩短总手术时间，并减少术后第7天的血红蛋白损失。
