抗凝治疗对全膝关节表面置换术后疗效的影响  

The influence of anticoagulant therapy on the curative effect after total knee arthroplasty

作　　者：张勋梦 孟庆奇[1] 王敏[1] 唐盛辉[2] 奉振成 李斯明[1] 

机构地区：[1]暨南大学第四附属医院广州市红十字会医院骨科,广州510220 [2]南方医科大学第五附属医院,广州510900

出　　处：《广州医药》2015年第3期19-22,共4页Guangzhou Medical Journal

摘　　要：目的通过比较利伐沙班、依若肝素和非抗凝治疗对全膝关节表面置换术后的疗效,分析全膝关节置换术后抗凝治疗的必要性、有效性及安全性。方法选取2010年1月—2013年8月我科收治的全膝关节表面置换术的患者154例,按治疗方式分成利伐沙班组(A组)、依若肝素钠组(B组)及非抗凝组(C组)。观察各组术后静脉血栓栓塞发生率;术前及用药后凝血功能指标的变化;术后总失血量、显性失血量、隐性失血量;伤口情况;膝关节功能HSS评分。结果 A组与B组术后无静脉栓塞症发生,C组出现静脉栓塞症3例;A、B、C三组术前与术后凝血功能指标差异均无统计学意义(P>0.05);B组术后显性失血量高于A组(P<0.05);三组患者术前及术后各回访时间点膝关节功能HSS评分差异无统计学意义(P>0.05)。结论抗凝药物预防全膝关节置换术后静脉血栓栓塞症的效果确切,利伐沙班与依若肝素疗效相当;抗凝治疗不会增加术后失血量及伤口并发症的发生率,且对术后膝关节中期功能恢复无影响。全膝关节表面置换术后使用抗凝治疗效果良好,安全性可。Objective To compare the influence of anticoagulant therapy on the curative effect after total knee arthro- plasty and evaluate the necessity, effectiveness and safety of anticoagulant therapy. Methods 154 patients after total knee ar- throplasty from January 2010 to August 2013 in our department were divided into the rivaroxaban group （ group A） , the enoxapa- rin group （B group） and non antieoagulation group （group C） according to the treatments. It was observed that the postoperative venous thromboembolism incidence; changes of blood coagulation indexes before and after the operation; the total blood loss, dominant blood loss and hidden hemorrhage; the wound; the HSS score of knee function. Results None of postoperative ve- nous thromboembolism occurred in group A and B, three cases of venous thromboembolism in group C; The differences of be- tween preoperative and postoperative coagulation indexes in three groups had no statistical significance （ P 〉 0. 05 ） ; Dominant blood loss in group B was significantly higher than that of group A （ P 〈 0. 05 ） ; No statistical significance in the HSS scores of knee function of three group （ P 〉 0. 05 ）. Conclusion The effect of anticoagulant drugs on the prevention of venous thrombo- embolism after total knee arthroplasty is effective, same efficacy in the treatment with rivaroxaban or enoxaparin ; anticoagulant therapy does not significantly increase the postoperative blood loss and the incidence of wound complications, does not influence the recovery of postoperative mid-term knee function. The use of anticoagulation therapy after total knee arthroplasty has good effect and be safety.

关 键 词：抗凝治疗 全膝关节表面置换 静脉血栓栓塞症 

分 类 号：R687.4[医药卫生—骨科学]