Application Of Tranexamic Acid In The Treatment Of Elbow Stiffness

Objective : Elbow joint stiffness is one of the most common complications of elbow joint dysfunction after elbow injury.There are many problems such as large amount of intraoperative bleeding,postoperative swelling of joint,blood in the joint,effusion and so on,which affect the early postoperative exercise,and then affect the prognosis of the patients with elbow dissection.This research proposed in the application of tranexamic acid before the elbow joint arthrolysis,to reduce intraoperative bleeding and perioperative joint and tissue bleeding,promote the postoperative rehabilitation and reduce the recurrence of heterotopic ossification.We intends to study its application in the treatment of elbow stiffness in the effectiveness and safety.And lay the basis for the treatment of stiff elbow perioperative management.Methods:This research is a prospective randomized clinical trial.Patients of our center underwent traumatic stiff elbow elbow and received elbow joint arthrolysis surgery were randomly divided into two groups.The experimental group 30 minutes before operation to intravenous drip of tranexamic acid,control group were not administered.After two groups of patients were under the guidance of doctors to actively carry out the joint function rehabilitation training to improve joint mobility.Through 1 days of blood and biochemical indexes on patients before and after surgery,combined with patient's age,weight,gender and other factors generally calculate the amount of bleeding in patients,and through the comparison records after 1 days,2 days,3 days,5 days and 7 days in patients with intra-articular drainage,thus to decrease postoperative evaluation and postoperative joint errhysis hemostatic effect of tranexamic acid and reduce the efficacy of joint effusion after operation.By comparing the two groups of patients after the operation on the 1st day,the 2nd day,the 3rd day,and the 5th day,Visual Analogue Score pain scale was used to evaluate the potential effect of reducing pain after the functional exercise.To evaluate the effectiveness of elbow joint mobility and elbow function score in the treatment of elbow stiffness by comparing the preoperative and postoperative 2 weeks,the 6 weeks,3 months,and 6 months.6 weeks,3 months and 6 months after the operation,the patients were examined with X rays,and Hastings-Graham scale was used to evaluate the heteroopic ossification occurrence.Patients' preoperative and postoperative liver function,renal function index 1 days(alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,total bilirubin,serum creatinine,blood urea nitrogen)were recorded to detect liver and kidney damage caused by identify hemostatic drugs that may exist in the evaluation of tranexamic acid in stiff elbow cut loose safety intravenous solution before the operation.Results:The intraoperative blood loss was estimated by the two methods of hemoglobin and hematocrit,and the blood loss in the experimental group was significantly lower than that in the control group(P<0.05).The experimental group of 1 days,on the 2 day,the 3 day of the intra articular injection flow rate was significantly reduced compared with the control group,with statistical significance(P<0.05),after the operation of the fifth day,the seventh day of the flow between the group no difference.The Visual Analogue Score of the experimental group was significantly lower than that of the control group(P<0.05)at the 1 day,the 2 day,the 3 day and the 5 day after operation,and there was no significant difference between the two groups(P>0.05).The experimental group in the 1 day after operation,the 2 day,the 3 day,in the 2 to June,the elbow joint activity was better than the control group,with statistical difference(P<0.05).The elbow joint function score test group was better than the control group at 2 weeks,6 weeks and March follow-up,but there was no significant difference between the control group and the control group in June.Hastings classification of heterotopic ossification occurred in the I group,and the recurrence rate was significantly lower(P<0.05)than that in the control group,but there was a trend of decrease in the recurrence of grade II heterotopic ossification,but did not reach statistical significance.In terms of safety evaluation,the two groups of patients before and after operation of liver and kidney function were not statistically significant,there were no brain,pulmonary embolism and other adverse events,suggesting that tranexamic acid in stiff elbow incision arthrolysis in application of liver function damage less risk.conclusion:The intravenous application of tranexamic acid before the elbow stiffness arthrolysis can effectively reduce postoperative bleeding and joint effusion in the elbow,and improve the patient's postoperative functional exercise and prognosis,reduce the postoperative recurrence of heterotopic ossification.There is no obvious risk in the application of tranexamic acid before elbow stiffness arthroysis for patient without liver and kidney disease and cardiovascular anticoagulation,which intends the application is safe and effective.