术中使用氨甲环酸可减少双束前交叉韧带重建术后的关节积血，并改善早期功能预后。
Intraoperative tranexamic acid reduces postoperative haemarthrosis and improves early functional outcomes in double-bundle anterior cruciate ligament reconstruction.
作者信息
Cen Li, Liu Hua, Li Ming, Zhang Yun-Feng, Zhang Hao-Jun, Huang Zhe-Yu
机构信息
The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, Ningbo, China, 315040, 1059# ZhongShan East Road, Ningbo, Zhejiang, People's Republic of China.
出版信息
J Orthop. 2024 Dec 10;65:51-56. doi: 10.1016/j.jor.2024.12.005. eCollection 2025 Jul.
INTRODUCTION
Double-bundle anterior cruciate ligament reconstruction (ACLR) has biomechanical advantages but is associated with increased intraoperative bleeding. The role of tranexamic acid (TXA) in reducing postoperative joint haemarthrosis and improving the short-term outcomes of double-bundle ACLR has not yet been thoroughly investigated. This study aimed to assess the effects of intraoperative TXA on postoperative joint haemarthrosis and short-term functional outcomes in patients who underwent double-bundle ACLR.
METHODS
This retrospective cohort study included 80 male patients who underwent double-bundle ACLR between January 2019 and December 2022. The patients were divided into two groups: those who received TXA and those that did not. The TXA group received 50 mL of TXA (10 mg/mL) intravenously approximately 10 min before tourniquet release, followed by an intra-articular injection of 50 mL TXA (10 mg/mL) immediately after wound closure, prior to tourniquet release, whereas the control group did not receive TXA. Primary outcomes included postoperative haemarthrosis volume, assessed using Coupens and Yate (CY) values; and short-term functional recovery, evaluated using range of motion (ROM), quadriceps strength, and visual analogue scale (VAS) pain scores on day 1, day 15, week 6, and week 12 postoperatively.
RESULTS
Intraoperative administration of TXA in patients undergoing double-bundle ACLR reduced postoperative haemarthrosis, as measured by a lower CY value on postoperative day 1 (P = 0.004) and day 15 (P < 0.001). Compared to patients in the control group, patients in the TXA group reported lower VAS pain scores on day 1 (P < 0.001), day 15 (P < 0.001), and week 6 (P = 0.028), together with improved quadriceps strength (P = 0.043, day 1; P = 0.009, day 15) and ROM (P < 0.001, 12 weeks postoperatively) during the early postoperative period.
CONCLUSION
The use of TXA during double-bundle ACLR may reduce postoperative joint haemarthrosis and enhance short-term functional outcomes.
引言
双束前交叉韧带重建术（ACLR）具有生物力学优势，但术中出血较多。氨甲环酸（TXA）在减少双束ACLR术后关节积血及改善短期疗效方面的作用尚未得到充分研究。本研究旨在评估术中使用TXA对接受双束ACLR患者术后关节积血及短期功能结局的影响。
方法
本回顾性队列研究纳入了2019年1月至2022年12月期间接受双束ACLR的80例男性患者。患者分为两组：接受TXA治疗的患者和未接受TXA治疗的患者。TXA组在松开止血带前约10分钟静脉注射50 mL TXA（10 mg/mL），然后在伤口闭合后、松开止血带前立即关节腔内注射50 mL TXA（10 mg/mL），而对照组未接受TXA治疗。主要结局包括术后积血体积，采用库彭斯和耶茨（CY）值评估；以及短期功能恢复情况，通过术后第1天、第15天、第6周和第12周的关节活动范围（ROM）、股四头肌力量和视觉模拟量表（VAS）疼痛评分进行评估。
结果
接受双束ACLR的患者术中使用TXA可减少术后积血，术后第1天（P = 0.004）和第15天（P < 0.001）的CY值较低。与对照组患者相比，TXA组患者在术后第1天（P < 0.001）、第15天（P < 0.001）和第6周（P = 0.028）的VAS疼痛评分较低，术后早期股四头肌力量（术后第1天，P = 0.043；术后第15天，P = 0.009）和ROM（术后12周，P < 0.001）有所改善。
结论
双束ACLR术中使用TXA可能减少术后关节积血并改善短期功能结局。
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