氨甲环酸控制肩关节镜术后关节腔出血的临床研究

目的:探讨氨甲环酸控制肩关节镜术后关节腔出血的临床疗效。方法:自2018年2月至7月,将60例肩关节镜下治疗肩袖撕裂患者随机分为观察组和对照组,每组30例。观察组男6例,女24例,年龄55～70(62.3±5.5)岁;病程2～36(11.7±1.7)个月;术后关节腔及肩峰下各注射0.5 g氨甲环酸(1 g氨甲环酸用生理盐水稀释至20 ml)。对照组男5例,女25例;年龄56～72(63.4±5.8)岁;病程4～36(10.8±1.4)个月;关节腔及肩峰下各注射生理盐水10 ml。比较两组患者术前及术后1 d血红蛋白值,测量术前及术后1、7 d肩关节周径并计算肩关节周径差值,记录皮下瘀血瘀斑及深静脉血栓等并发症。结果:术前及术后1 d两组血红蛋白值比较差异无统计学意义(P0.05);术后1 d的观察组肩关节周径(32.9±0.3) cm小于对照组的(35.1±0.5) cm;肩关节周径差值(8.7±0.4) mm低于对照组的(12.3±0.5) mm;但术后7 d,两组肩关节周径及肩关节周径差值比较差异无统计学意义(P0.05)。观察组2例出现皮下瘀斑,对照组6例出现皮下瘀斑,两组比较差异无统计学意义(P0.05);两组患者均未发生深静脉血栓。结论:肩峰下及关节腔注射氨甲环酸能明显减轻肩关节镜术后早期软组织肿胀,具有较好的安全性。

Clinical study on the control of intra-articular hemorrhage by tranexamic acid after shoulder arthroscopy

Objective: To explore clinical effects of tranexamic acid on postoperative intra-articular hemorrhage after shoulder arthroscopy.Methods: From February to July 2018,60 patients with rotator cuff tears treated by shoulder arthroscopy were randomly divided into observation group and control group,30 cases in each group. In observation group,there were 6 males and 24 females; aged from 55 to 70 years old with an average age of (62.3±5.5) years;the courses of disease ranged from 2 to 36 months with an average of (11.7±1.7) months;received 0.5 g tranexamic acid (1 g of tranexamic acid was diluted with normal saline to 20 ml) in each articular cavity and subacromial space after operation. In control group,there were 5 males and 25 females;aged from 56 to 72 years old with an average of (63.4±5.8) years old;the courses of disease ranged from 4 to 36 months with an average of(10.8±1.4) months;10 ml of normal saline was injected into joint cavity and subacromial space. Hemoglobin values between two groups before and after operation at 1 day were recorded,circumference of shoulder joint was measured preoperatively and the 1st and 7th days after operation,and circumference difference of shoulder joint was recorded. Complications such as subcutaneous blood stasis and DVT were recorded.Results: There was no significant difference in hemoglobin values between two groups before and after operation at 1 day(P>0.05). On the first day after surgery,peripheral diameter of shoulder joint in observation group(32.9±0.3) cm] was significantly lower than that in control group(35.1±0.5) cm],and the circumference difference of shoulder joint in observation group(8.7±0.4) mm] was also significantly lower than that in control group(12.3±0.5) mm],the difference was statistically significant (P<0.05). However,there was no significant difference in circumference of shoulder joint and the difference in circumference of shoulder joint between two groups on the 7th day after operation(P>0.05). Two patients in observation group occurred subcutaneous ecchymosis,while 6 patients occurred in control group,but without statistical difference between two groups(P>0.05).Conclusion: Subacromial and articular injection of tranexamic acid could significantly reduce early swelling of soft tissue after arthroscopic shoulder surgery,and it has better safety.