关节镜下应用氨甲环酸联合富血小板血浆注射治疗髋关节撞击综合征的效果

Application of tranexamic acid combined with platelet-rich plasma injection under arthroscopy for the treatment of femoroacetabular impingement syndrome

目的探讨关节镜下应用氨甲环酸联合富血小板血浆(platelet-rich plasma,PRP)注射治疗髋关节撞击综合征的效果。方法选取行关节镜治疗的髋关节撞击综合征患者60例作为研究对象。采用随机数字表法分为观察组和对照组,每组30例。对照组采用PRP治疗,观察组采用氨甲环酸联合PRP治疗。比较2组术中失血量、总失血量、住院时间及使用PRP前凝血功能[凝血酶原时间(prothrombin time,PT)、活化部分凝血酶原时间(activated partial prothrombin time,APTT)],采用关节镜视野能见度评分量表评分对患者术中视野进行评分,CT检查测量患者α角、中心边缘角,采用疼痛视觉模拟评分法(visual analogue scale,VAS)、非关节炎髋评分(Non-arthritic hip score,NAHS)、Harris髋关节功能评分(Harris hip function score,HHS)对患者疼痛程度及髋关节功能进行评分。比较2组临床疗效。结果观察组术中失血量、总失血量、住院时间、PT、APTT水平显著低于对照组,视野清晰度评分高于对照组(P<0.05);2组术后12个月α角、中心边缘角显著低于术前(P<0.05);随时间延长,2组VAS评分呈逐渐降低趋势,NAHS评分、HHS评分呈逐渐升高趋势,观察组VAS评分低于对照组,NAHS评分、HHS评分高于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。结论氨甲环酸联合PRP注射在髋关节撞击综合征关节镜围术期患者中应用,可有效提高术中视野清晰度,减少出血量,减轻疼痛,促进术后髋关节功能的早期康复。

Objective To explore the effect of application of tranexamic acid combined with platelet-rich plasma(PRP)injection under arthroscopy in the treatment of femoroacetabular impingement syndrome(FAIS).Methods Sixty patients with FAIS who underwent arthroscopic treatment were selected as the research subjects,and then divided into an observation group(n=30)and a control group(n=30)using a random number table method.The control group was treated with PRP,while the observation group was treated with tranexamic acid combined with PRP.Intraoperative blood loss,total blood loss,length of hospital stay,and coagulation function[prothrombin time(PT),activated partial prothrombin time(APTT)]before using PRP were compared between two groups.The arthroscopic visual field visibility scale score was used to evaluate the intraoperative visual field of patients,and CT examination was performed to measure angle α and center-edge angle(CEA)of the patients.Visual analog scale(VAS),non-arthritic hip score(NAHS),and Harris hip function score(HHS)were used to assess the severity of pain and hip function of patients,and the clinical efficacy of two groups was compared.Results The intraoperative blood loss,total blood loss,length of hospital stay,PT and APTT levels in the observation group were significantly lower than those in the control group,and the visual field clarity score was higher than that in the control group(P<0.05).At 12 months after surgery,angleαand CEA of the two groups were significantly lower than those before surgery(P<0.05).The VAS scores of the two groups showed a gradually decreasing trend with time,while the NAHS and HHS scores showed a gradually increasing trend.The VAS scores of the observation group were lower than those of the control group,while the NAHS and HHS scores were higher than those of the control group.There was a statistically significant difference in the interaction between groups,time points,and time points between groups(P<0.05).Conclusion The application of tranexamic acid combined with PRP injection in perioperative patients with FAIS under arthroscopy can effectively improve the visual field clarity during operation,reduce blood loss,relieve pain and promote the early rehabilitation of hip joint function after operation.