Alzobi Osama Z, Derbas Jawad, Toubasi Ahmad, Hantouly Ashraf, Abdullah Abdullah, Zikria Bashir, Alkhatib Nedal
Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
Faculty of Medicine, University of Jordan, Amman, Jordan.
JSES Int. 2024 Apr 6;8(5):995-1003. doi: 10.1016/j.jseint.2024.03.009. eCollection 2024 Sep.
Rotator cuff disease, a prevalent cause of shoulder disability and pain among middle-aged and older adults, has seen an uptick in arthroscopic repairs in the last 2 decades. These repairs necessitate optimal visualization and controlled hemostasis to prevent complications. This study aimed to assess the efficacy of tranexamic acid (TXA) in arthroscopic rotator cuff repairs by evaluating all available randomized controlled trials (RCTs) in the literature.
A systematic search was conducted in PubMed, Cochrane Library, Embase, Science Direct, Web of Science, Google Scholar, and CINAHL databases from inception through November 2022 for RCTs investigating the use of TXA in arthroscopic rotator cuff repair. The studies selected reported on the primary outcomes, which include visual clarity during surgery, postoperative pain, and operative time. The quality of the studies was evaluated using the RoB 2 (Risk of Bias) tool.
A total of 7 studies, with level I and II of evidence, comprising 510 randomized patients (253 females, 257 males) were included, with mean ages of 59 and 58 years for the TXA and control groups, respectively. Bias was graded "Low" in 2 RCTs and "Some concerns" in 5 RCTs. Visual analog scale for pain was significantly different with TXA use at postoperative day 1 (weighted mean difference (WMD) = -0.55; 95% confidence interval (CI): -1.07 to -0.04, = .04). Operative time was significantly higher for the control group with a mean difference of 7.97 minutes (WMD = -7.97; 95% CI: -15.19 to -0.74, = .04). The impact of TXA on visual clarity during shoulder arthroscopy remains uncertain. However, postoperative shoulder swelling results were comparable in both groups (WMD = -1.71; 95% CI: -3.72 to 0.29, I = 99% (where I = heterogeneity statistic), = .69). Considerable heterogeneity was seen in some results.
Pooled data suggest that the use of TXA in shoulder arthroscopy does reduce postoperative shoulder pain and has a positive effect on decreasing operative time. However, the reduction in pain may not be clinically significant, and there is no effect on reducing shoulder swelling. The impact of TXA on visual clarity remains inconclusive, and further research is needed using methodologically rigorous articles that incorporate objective measures and controlled factors to eliminate subjective bias.
肩袖疾病是中老年人群肩部功能障碍和疼痛的常见原因，在过去20年中，关节镜修复手术有所增加。这些修复手术需要最佳的视野和可控的止血以预防并发症。本研究旨在通过评估文献中所有可用的随机对照试验（RCT）来评估氨甲环酸（TXA）在关节镜下肩袖修复中的疗效。
从创刊至2022年11月，在PubMed、Cochrane图书馆、Embase、Science Direct、Web of Science、谷歌学术和CINAHL数据库中进行系统检索，以查找研究TXA在关节镜下肩袖修复中应用的RCT。入选的研究报告了主要结局，包括手术中的视觉清晰度、术后疼痛和手术时间。使用RoB 2（偏倚风险）工具评估研究质量。
共纳入7项证据等级为I级和II级的研究，包括510例随机分组的患者（253例女性，257例男性），TXA组和对照组的平均年龄分别为59岁和58岁。2项RCT的偏倚等级为“低”，5项RCT的偏倚等级为“有些担忧”。术后第1天使用TXA时，疼痛视觉模拟量表有显著差异（加权平均差（WMD）=-0.55；95%置信区间（CI）：-1.07至-0.04，P=0.04）。对照组的手术时间显著更长，平均差为7.97分钟（WMD=-7.97；95%CI：-15.19至-0.74，P=0.04）。TXA对肩关节镜检查时视觉清晰度的影响仍不确定。然而，两组术后肩部肿胀结果相当（WMD=-1.71；95%CI：-3.72至0.29，I²=99%（I²为异质性统计量），P=0.69）。一些结果存在相当大的异质性。
汇总数据表明，在肩关节镜检查中使用TXA确实可减轻术后肩部疼痛，并对缩短手术时间有积极作用。然而，疼痛减轻可能在临床上并不显著，且对减轻肩部肿胀没有效果。TXA对视觉清晰度的影响尚无定论，需要使用纳入客观测量和可控因素以消除主观偏倚的方法严谨的文章进行进一步研究。
