Sports Medicine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Sports Medicine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
J Shoulder Elbow Surg. 2024 Dec;33(12):2671-2679. doi: 10.1016/j.jse.2024.06.009. Epub 2024 Aug 2.
Tranexamic acid (TXA) reduces bleeding and hematoma rates in open elbow arthrolysis. However, its effects on arthroscopic elbow arthrolysis remain unclear. This study aims to evaluate the effect of TXA on elbow arthroscopic procedures and compare bleeding volume, hemarthrosis, visual analog scale (VAS) for pain, range of motion (ROM), and Mayo Elbow Performance Score (MEPS) in the early postoperative period between patients who received intra-articular TXA and those who did not.
A prospective, double-blind, randomized controlled trial enrolling 80 patients with stiff elbows who underwent arthroscopic arthrolysis was performed from January 2021 to December 2022. Intra-articularly, 1 g of TXA in 100 ml of saline or placebo (control group) was administered after the arthroscopic operation according to randomization. Parameters were recorded and compared between the groups, including bleeding volume of drainage, hemoglobin (Hgb) level, ratio of arm and forearm circumference of the surgical side to the contralateral side, grading of hematoma, VAS, ROM, and MEPS within 1 week postoperatively. And during 1 year follow-up, ROM and MEPS were recorded.
All patients enrolled in this study demonstrated significant improvements in ROM (flexion-extension) and MEPS 1 week postoperatively, with no significant differences observed between the 2 groups. Compared to the control group, the TXA group exhibited significant differences in the bleeding volume of drainage (61.45 ± 47.7 ml vs. 89.8 ± 47.0 ml, P = .030) and a higher Hgb level 24 hours postoperatively (13.5 ± 1.5 g/dL vs. 12.6 ± 1.8 g/dL P = .049). While the ratio of arm and forearm circumferences significantly increased 24 hours postoperatively compared to preoperative values in TXA group (1.05 ± 0.06 vs. 1.02 ± 0.04 and 1.02 ± 0.06 vs. 0.98 ± 0.04, with P = .019 and P = .005, respectively), this difference vanished 1 week postoperatively for the ratio of arm circumference. However, it persisted for the ratio of forearm circumference (1.02 ± 0.07 vs. 0.98 ± 0.04, P = .003). Furthermore, there was no significant difference in MEPS, VAS, or ROM between the 2 groups 1 week postoperatively.
Patients with stiff elbows who underwent arthroscopic arthrolysis achieved satisfactory clinical outcomes very early postoperatively. Compared to the control group, patients who underwent arthroscopic elbow arthrolysis with intra-articular administration of TXA exhibited significantly less bleeding volume of drainage and slightly higher Hgb levels postoperatively. One week postoperatively, slightly more swelling in the upper arm region was noted in the control group compared to the TXA group. These findings suggest that the intra-articular injection of TXA after arthroscopic release for elbow stiffness may statistically reduce complications related to postoperative bleeding. However, it's clinical relevance needs further investigation.
氨甲环酸（TXA）可减少开放性肘松解术的出血和血肿发生率。然而，其对关节镜下肘松解术的影响尚不清楚。本研究旨在评估 TXA 对内窥镜下肘松解术的影响，并比较接受关节内 TXA 治疗和未接受治疗的患者的出血量、关节积血、视觉模拟评分（VAS）疼痛评分、活动度（ROM）和术后早期 Mayo 肘功能评分（MEPS）。
2021 年 1 月至 2022 年 12 月，前瞻性、双盲、随机对照试验纳入 80 例接受关节镜松解术的僵硬肘患者。根据随机分组，在关节镜手术后关节内给予 1g TXA 加 100ml 生理盐水或安慰剂（对照组）。记录并比较两组患者的引流出血量、血红蛋白（Hgb）水平、手术侧手臂和前臂周径与对侧周径的比值、血肿分级、VAS、ROM 和术后 1 周的 MEPS。在 1 年随访期间，记录 ROM 和 MEPS。
所有入组患者术后 1 周 ROM（屈伸）和 MEPS 均显著改善，两组间无显著差异。与对照组相比，TXA 组引流出血量（61.45±47.7ml 比 89.8±47.0ml，P=0.030）和术后 24 小时 Hgb 水平（13.5±1.5g/dL 比 12.6±1.8g/dL，P=0.049）有显著差异。TXA 组术后 24 小时手臂和前臂周径比值较术前显著增加（1.05±0.06 比 1.02±0.04 和 1.02±0.06 比 0.98±0.04，P=0.019 和 P=0.005），但术后 1 周手臂周径比值消失。然而，前臂周径比值仍有差异（1.02±0.07 比 0.98±0.04，P=0.003）。术后 1 周，两组间 MEPS、VAS 或 ROM 无显著差异。
接受关节镜松解术的僵硬肘患者术后早期获得了满意的临床效果。与对照组相比，接受关节内 TXA 治疗的患者术后引流出血量明显减少，Hgb 水平略高。术后 1 周，对照组上臂肿胀程度略高于 TXA 组。这些发现表明，关节镜松解术后关节内注射 TXA 可能在统计学上减少与术后出血相关的并发症。但需要进一步的临床研究来评估其临床意义。
