Meng Weihao, Xuan Lingzhe, Li Fengfeng, Zhang Zitao
Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China.
Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing Jiangsu, 210008, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Nov 15;38(11):1330-1335. doi: 10.7507/1002-1892.202407012.
To explore the effect of intravenous tranexamic acid on postoperative drainage and elbow joint function after traumatic elbow stiffness release.
The clinical data of 44 patients with elbow joint stiffness who were treated with release surgery between March 2022 and December 2023 and met the selection criteria were retrospectively analyzed. Among them, 20 patients were given intravenous infusion of 100 mL (1 g/100 mL, once a day) of tranexamic acid solution for 3 consecutive days after surgery (group A), and 24 patients were not treated with tranexamic acid after surgery (group B). There was no significant difference in baseline data such as gender, age, side, body mass index, initial injury, and preoperative hemoglobin, visual analogue scale (VAS) score, and Mayo elbow function score (MEPS), elbow flexion and extension activity between the two groups ( >0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, postoperative hospital stay, VAS score before operation and at 1, 2, and 3 days after operation, MEPS score before operation, at 3 months after operation, and at last follow-up, and elbow flexion and extension activity before operation and at last follow-up were recorded and compared between the two groups.
Both groups of patients successfully completed the operation, and there was no significant difference in operation time ( >0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, and postoperative hospital stay in group A were significantly less than those in group B ( <0.05). Both groups of patients were followed up 6-12 months, with an average of 8.6 months. No complications such as wound infection, elbow joint varus and varus instability or dislocation, and pulmonary embolism or other thromboembolic events occurred in either group. The VAS scores of both groups were significantly higher at 1 day and 2 days after operation than before operation ( <0.05); the VAS score of group A was significantly lower than that of group B ( <0.05). The VAS scores of both groups decreased to the preoperative level at 3 months after operation, and there was no significant difference between the two groups ( >0.05). At 3 months after operation and at last follow-up, the MEPS scores of both groups significantly improved when compared with those before operation ( <0.05); there was no significant difference between the two groups ( >0.05). At last follow-up, the postoperative elbow flexion and extension activity of the two groups significantly increased when compared with that before operation ( <0.05); there was no significant difference in change of elbow flexion and extension activity between the two groups ( >0.05).
Intravenous tranexamic acid for 3 consecutive days after release of traumatic elbow stiffness can significantly reduce postoperative drainage volume, shorten drainage tube indwelling time and hospital stay, and relieve early postoperative pain, but it has no effect on the risk of thrombotic and embolic events and postoperative elbow function.
探讨静脉注射氨甲环酸对创伤性肘关节僵硬松解术后引流及肘关节功能的影响。
回顾性分析2022年3月至2023年12月期间接受松解手术且符合入选标准的44例肘关节僵硬患者的临床资料。其中，20例患者术后连续3天静脉输注100 mL（1 g/100 mL，每日1次）氨甲环酸溶液（A组），24例患者术后未使用氨甲环酸治疗（B组）。两组患者的性别、年龄、患侧、体重指数、初始损伤、术前血红蛋白、视觉模拟评分（VAS）、Mayo肘关节功能评分（MEPS）、肘关节屈伸活动度等基线资料比较，差异无统计学意义（>0.05）。记录并比较两组患者术后1天、3天的引流量、总引流量、引流管留置时间、术后住院时间、术前及术后1天、2天、3天的VAS评分、术前、术后3个月及末次随访时的MEPS评分，以及术前及末次随访时的肘关节屈伸活动度。
两组患者均成功完成手术，手术时间比较，差异无统计学意义（>0.05）。A组患者术后1天、3天的引流量、总引流量、引流管留置时间及术后住院时间均显著少于B组（<0.05）。两组患者均随访6～12个月，平均8.6个月。两组均未发生伤口感染、肘关节内翻及内翻不稳定或脱位、肺栓塞或其他血栓栓塞事件等并发症。两组患者术后1天、2天的VAS评分均显著高于术前（<0.05）；A组VAS评分显著低于B组（<0.05）。两组患者术后3个月VAS评分均降至术前水平，两组间差异无统计学意义（>0.05）。术后3个月及末次随访时，两组患者的MEPS评分均较术前显著改善（<0.05）；两组间差异无统计学意义（>0.05）。末次随访时，两组患者术后肘关节屈伸活动度均较术前显著增加（<0.05）；两组肘关节屈伸活动度变化差异无统计学意义（>0.05）。
创伤性肘关节僵硬松解术后连续3天静脉注射氨甲环酸可显著减少术后引流量，缩短引流管留置时间及住院时间，减轻术后早期疼痛，但对血栓栓塞事件风险及术后肘关节功能无影响。
