局部使用氨甲环酸在关节镜下肘关节松解中的临床效果

目的观察局部应用氨甲环酸在关节镜下肘关节松解术后的疗效。 方法2018年3月至2020年2月对61例肘关节僵硬患者行关节镜下肘关节松解术,根据入院时间及术中是否局部使用氨甲环酸分为A、B两组,A组患者2018年3月至2019年2月进行手术,术中未局部使用氨甲环酸;B组患者于2019年3月至2020年2月行手术,术中使用氨甲环酸关节腔灌注。术后比较两组引流血量、视觉模拟评分法（visual analogue scale/score, VAS）、肘关节活动度、Mayo肘关节功能评分等指标。 结果B组患者术后第1天、第2天引流及总引流量均低于A组,其中B组术后总引流量（45±35）ml,A组为（109±76）ml,差异有统计学意义（P< 0.05）。两组患者术后肘关节活动均明显改善,末次随访B组活动范围丢失角度明显小于A组,B组7°±9°,A组15°±14°,差异有统计学意义（P<0.05）。 结论局部应用氨甲环酸可以有效减少关节镜下肘关节松解术后关节腔引流量、术后早期疼痛及术后关节活动范围丢失,利于肘关节术后功能康复。

Clinical effect of topical application of tranexamic acid on arthroscopic elbow arthrolysis

BackgroundElbow stiffness was defined as all loss of motion with a limitation in extension greater than 30° and a flexion less than 120°. The etiology is mainly divided into two types. The intra-articular factors mainly include post-traumatic arthritis and joint adversarial hyperplastic synovitis, and the extra-articular factors mainly include ectopically ossified joint capsule contracture and tendon contracture. It is reported that the incidence of elbow movement limitation and stiffness was up to 5% after the elbow trauma or surgery, and 12% of the elbow stiffness caused by injuries around the elbow joint. Compared with the traditional open arthrolysis, arthroscopic arthrolysis had smaller incision, less bleeding, and less postoperative pain, which were conducive to early recovery. For the patients with elbow stiffness caused by intra-articular factors, arthroscopic surgery should be considered if the range of motion was not fully improved or continuously impaired after 6 to 10 months of conservative treatment. Tranexamic acid is an antifibrinolytic drug. In recent years, tranexamic acid had been widely used in orthopaedic surgery, such as total knee replacement, total hip replacement, spine surgery, etc. It had been proved to have good efficacy and safety in reducing postoperative bleeding. In arthroscopic meniscus resection and anterior cruciate ligament reconstruction, the use of tranexamic acid reduced postoperative knee joint hemorrhage, swelling and early postoperative pain. At present, there is a lack of literature on the efficacy of topical tranexamic acid after arthroscopic treatment of elbow stiffness. ObjectiveTo observe the effect of topical application of tranexamic acid (TXA) on arthroscopic elbow arthrolysis. MethodsFrom March 2018 to February 2020, 61 patients with elbow stiffness underwent arthroscopic elbow arthrolysis. They were divided into group A and B according to the admission time and whether use TXA or not. Patients in group A underwent surgery without TXA from March 2018 to February 2019, while those in group B underwent surgery with TXA from March 2019 to February 2020. The drainage volume, VAS score, elbow range of motion and Mayo elbow function score were compared between two groups. ResultsThe postoperative drainage volumes on day 1, day 2 and the total drainage volume in group B were all less than those in group A. The postoperative total drainage volume in group B was (45±35) ml, while it was (109±76) ml in group A, and the difference was statistically significant (P<0.05) . The postoperative elbow range of motion (ROM) was significantly improved in both groups. The loss of postoperative ROM in group B was less than that in group A (7°±9° in Group B vs. 15°±14° in group A, P < 0.05) at the last follow-up, and the difference was statistically significant. ConclusionTopical application of tranexamic acid was effective on patients who underwent arthroscopic elbow arthrolysis in reducing the postoperative drainage volume, the early postoperative pain and the loss of postoperative ROM, and it was beneficial to the postoperative functional rehabilitation.