摘要
目的探讨创伤性肘关节僵硬松解术后静脉应用氨甲环酸对术后引流量和肘关节功能预后的影响。方法回顾分析2022年3月—2023年12月收治且符合选择标准的44例肘关节僵硬行松解术治疗患者临床资料。其中20例术后连续3 d静脉滴注氨甲环酸溶液100 mL(1 g/100 mL,每日1次;A组),24例术后未应用氨甲环酸(B组)。两组患者性别、年龄、侧别、身体质量指数、初次损伤情况及术前血红蛋白、疼痛视觉模拟评分(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均无统计学意(P>0.05)。记录并比较两组患者术后1、3 d引流量和总引流量,留置引流管时间,术后住院时间,术前、术后1、2 d及3个月VAS评分,术前、术后3个月及末次随访时MEPS评分,术前及末次随访时肘关节屈伸活动度等指标。结果两组患者均顺利完成手术,手术时间比较差异无统计学意义(P>0.05)。A组术后1 d和3 d引流量、总引流量、留置引流管时间和术后住院时间均明显少于B组,差异有统计学意义(P<0.05)。两组患者均获随访,随访时间6~12个月,平均8.6个月。两组均未发生切口感染、肘关节内外翻不稳定或脱位等并发症及肺栓塞等血栓或栓塞事件。术后1、2 d两组VAS评分均较术前显著升高,差异有统计学意义(P<0.05);A组VAS评分低于B组,差异有统计学意义(P<0.05)。术后3个月两组VAS评分均降至接近术前水平,与术前比较差异无统计学意义(P>0.05),两组间比较差异亦无统计学意义(P>0.05)。术后3个月及末次随访时,两组MEPS评分均较术前显著改善,差异有统计学意义(P<0.05);两组间比较差异无统计学意义(P>0.05)。末次随访时,两组术后肘关节屈伸活动度较术前显著增加,差异有统计学意义(P<0.05);两组间肘关节屈伸活动度变化值差异无统计学意义(P>0.05)。结论创伤性肘关节僵硬松解术后静脉连续应用3 d氨甲环酸可明显减少术后引流量、缩短引流管留置及住院时间,并缓解术后早期疼痛,并且对血栓及栓塞事件发生风险和肘关节功能无影响。
Objective To explore the effect of intravenous tranexamic acid on postoperative drainage and elbow joint function after traumatic elbow stiffness release.Methods 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(P>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.Results Both groups of patients successfully completed the operation,and there was no significant difference in operation time(P>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(P<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(P<0.05);the VAS score of group A was significantly lower than that of group B(P<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(P>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(P<0.05);there was no significant difference between the two groups(P>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(P<0.05);there was no signi-ficant difference in change of elbow flexion and extension activity between the two groups(P>0.05).Conclusion In-travenous 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.
作者
孟唯浩
铉令哲
黎逢峰
张子韬
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)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2024年第11期1330-1335,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金资助项目(81871762)
江苏省医学创新中心项目(CXZX202214)。
关键词
氨甲环酸
创伤性肘关节僵硬
肘关节松解术
引流量
Tranexamic acid
traumatic elbow joint stiffness
elbow arthrolysis
drainage volume
