氨甲环酸在髋关节撞击综合征关节镜手术中的应用

Clinical effects of tranexamic acid in arthroscope for femoroacetabular impingement

目的:探讨氨甲环酸在髋关节撞击综合征关节镜手术中的临床疗效。方法:回顾性分析2016年6月至2018年12月经髋关节镜治疗的34例髋关节撞击综合征患者(34髋),根据术前是否应用氨甲环酸(tranexamic acid,TXA),分为TXA组和对照组,每组17例。其中TXA组男10例,女7例;年龄20~49(32.1±7.6)岁;手术切口前10 min予15 mg/kg氨甲环酸静滴。对照组男11例,女6例;年龄20~49(30.9±6.2)岁;手术切口前10 min予生理盐水100 ml静滴。比较两组患者术中失血量及手术总失血量;分别于术后3、7 d采用疼痛视觉模拟评分(visual analogue scale,VAS)评价髋部疼痛缓解情况;于术后第3、6、9及12周采用髋关节改良Harris评分(modified Harris Hip Score,mHHS)进行疗效评价。结果:两组患者随访均超过12周。两组术后切口均愈合良好,无感染及深静脉血栓等并发症发生。两组手术时间比较差异无统计学意义(P>0.05);TXA组手术总失血量、术中失血量分别为(0.47±0.20)L、(0.18±0.08)L,对照组分别为(0.66±0.22)L、(0.24±0.01)L,两组比较差异有统计学意义(P<0.05)。两组术前及术后7 d VAS评分比较差异无统计学意义(P>0.05);术后3 d TXA组VAS评分2.35±1.12与对照组3.12±0.70比较差异有统计学意义(P<0.05);两组术后3、7 d VAS评分与术前比较差异有统计学意义(P<0.05)。术后3、6周TXA组mHHS评分分别为87.72±1.95、91.92±2.32,对照组分别为84.08±1.21、89.77±3.30;两组术后3和6周比较差异有统计学意义(P<0.05);而两组术后9、12周mHHS评分比较差异无统计学意义(P>0.05)。结论:术前应用氨甲环酸可有效减少髋关节撞击综合征关节镜手术失血量,从而改善手术视野,降低手术操作难度,同时能够促进术后髋关节功能的早期快速康复。

Objective:To evaluate the clinical effects of tranexamic acid in arthroscope for femoroacetabular impingement.Methods:Totally 34 patients(34 hips)with femoroacetabular impingement underwent hip arthroscopy from June 2016 to December 2018,were randomly divided into two groups named as tranexamic acid group and control group,17 patients in each group.In TXA group,there were 10 males and 7 females,aged from 20 to 49 years old with an average of(32.1±7.6)years old;15 mg/kg TXA was intravenous drops before operation incision performed at 10 min.In control group,there were 11 males and 6 females,aged from 20 to 49 years old with an average of(30.9±6.2)years old;100 ml normal saline was intravenous drops before operation incision performed at 10 min.Introopertaive and total blood loss between two groups were compared.Visual analogue scale(VAS)at 3 and 7 days after opertaion were used to evaluate pain relief of hip joint.Modified Harris Hip Score(mHHS)of hip joint at 3,6,9 and 12 weeks after oeprtaion were applied to evaluate clinical effects.Results:All patients were obtained follow-up over 12 weeks.Incision healed well without infection and deep vein thrombosis.There were no statistical difference in opertaion time bewteen two groups(P>0.05).Total blood loss and introopertaive blood loss in TXA group were(0.47±0.20)L and(0.18±0.08)L,while(0.66±0.22)L and(0.24±0.01)L in control group;there were statical differences between two groups(P<0.05).There were no dierences in VAS before opertaion and 7 days after opertaion between two groups(P>0.05);VAS at 3 days after opertaion in TXA group was 2.35±1.12 and 3.12±0.70 in control group,and had difference(P<0.05).There were significance in VAS at 3 and 7 days after opertaion compared with preopertaive between two groups(P<0.05).Postopertaive mHHS in TXA group at 3 and 6 weeks were 87.72±1.95 and 91.92±2.32,respectively;while 84.08±1.21 and 89.77±3.30 in control group;there were difference between two groups at 3 and 6 weeks after operation(P<0.05);there were no significant difference in mHHS between two groups at 9 and 12 weeks after operation(P>0.05).Conclusion:Preoper ative application of tranexamic acid could effectively reduce blood loss in arthroscopy for femoroacetabular impingement,thereby improving surgical field of vision,reducing difficulty of surgical operation,which could promote early and rapid rehabilitation of hip function.