Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
NYU Langone, New York, New York, USA.
Am J Sports Med. 2024 Dec;52(14):3673-3679. doi: 10.1177/03635465231216336. Epub 2024 Feb 12.
Several randomized controlled trials (RCTs) have been conducted to assess the use of tranexamic acid (TXA) in the setting of arthroscopic rotator cuff repair (ARCR). However, these studies have shown mixed results, with some showing improved intraoperative visualization, subsequent operative times, and pain levels, and others finding no difference.
To perform a systematic review of the RCTs in the literature to evaluate the use of TXA on ARCR.
Meta-analysis; Level of evidence, 1.
Two independent reviewers performed the literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with a third author resolving any discrepancies. RCTs comparing TXA with a control in ARCR were included. Visualization, postoperative pain, operative time, pump pressures, and shoulder swelling were evaluated. A value < .05 was deemed statistically significant.
Six RCTs with 450 patients were included in this review. Overall, 5 studies evaluated intraoperative visualization, with 3 studies finding a significant difference in favor of TXA. With TXA, patients had a lower mean postoperative visual analog scale (VAS) score of 3.3, and with the control, patients had a mean VAS score of 4.1, which was statistically significant ( = .001). With TXA, the mean weighted operation time was 79.3 minutes, and with the control, the mean operation time was 88.8 minutes, which was statistically significant ( = .001). No study found any difference in intraoperative pump pressures or swelling.
TXA improved visualization, operative time, and subsequent postoperative pain levels in patients undergoing ARCR.
已经进行了几项随机对照试验（RCT）来评估氨甲环酸（TXA）在关节镜肩袖修复（ARCR）中的使用。然而，这些研究结果喜忧参半，一些研究表明术中可视性、后续手术时间和疼痛水平得到改善，而其他研究则没有发现差异。
对文献中的 RCT 进行系统评价，以评估 TXA 在 ARCR 中的应用。
荟萃分析；证据水平，1 级。
两名独立的审查员根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行文献检索，第三位作者解决任何分歧。纳入比较 TXA 与 ARCR 对照组的 RCT。评估可视化、术后疼痛、手术时间、泵压和肩部肿胀。 值<0.05 被认为具有统计学意义。
本综述纳入了 6 项共 450 例患者的 RCT。总体而言，有 5 项研究评估了术中可视化，其中 3 项研究发现 TXA 具有显著优势。使用 TXA 的患者术后视觉模拟评分（VAS）均值为 3.3，而使用对照组的患者 VAS 均值为 4.1，具有统计学意义（ =.001）。使用 TXA 的患者平均加权手术时间为 79.3 分钟，而使用对照组的患者平均手术时间为 88.8 分钟，具有统计学意义（ =.001）。没有研究发现术中泵压或肿胀有任何差异。
TXA 改善了接受 ARCR 的患者的可视化、手术时间和随后的术后疼痛水平。
