初次髋、膝关节置换术后纤溶变化  

The kinetics and duration of fibrinolysis following primary total hip and knee arthroplasty. A pilot study

作　　者：谢锦伟[1] 姚欢[1] 岳辰[1] 马俊[1] 徐彬[1] 蔡迎春[1] 裴福兴[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国矫形外科杂志》2016年第10期931-936,共6页Orthopedic Journal of China

基　　金：卫计委2013年度卫生行业科研专项(编号:201302007)

摘　　要：[目的]探讨初次髋、膝关节置换术（total hip/knee arthroplasty,THA/TKA）后纤溶亢进持续时间及血栓弹力图在预测纤溶变化中的价值,指导临床个体化使用抗纤溶药。[方法]前瞻性连续纳入2015年3月-6月因终末期髋、膝关节疾病行初次髋、膝关节置换术患者,分别于术前,术后6、12、24、48 h采集静脉血行血栓弹力图、D-二聚体、纤维蛋白（原）降解产物（FDP）,对比观察血栓弹力图各参数（R、K、α、MA、CI、EPL、Ly30）、D-二聚体及FDP的变化趋势。[结果]共84例患者纳入研究,TKA 41例,THA 43例。术前、术后血栓弹力图各指标均在正常范围之内;与术前相比,术后6、12、24 h的R值缩短,CI值延长,差异有统计学意义（P〈0.001）;术前D-二聚体及FDP值均在正常范围,术后6、12、24、48 h明显升高,差异均有统计学意义（P〈0.001）;其中,术后6 h达到峰值,之后开始降低,FDP术后48 h基本降至正常。[结果]根据术后D-二聚体及FDP的变化趋势,初次髋、膝关节置换术后6 h纤溶亢进达峰值,持续约24 h。[ Objective] To explore the effect of kinetics and duration of hyperfibrinolysis with the thrombelastography （TEG） following primary total hip and knee arthroplasty （THA/TKA）. [ Method] Consecutive patients from March 2015 to June undergoing primary unilateral THA or TKA for end staged hip or knee disease were prospectively included. The TEG, D - Dimer and Fibrin degeneration products（FDPs） were tested preoperatively, and at H6, H12, H24 postoperatively. The index of TEG（ R, K, ct, MA, CI, EPL, Ly 30 ）, D - Dimer and FDP were recorded and analyzed. [ Result ] A total of 84 patients were in- eluded ,41 in TKA,43 in THA. The preoperative and postoperative index of TEG were normal. The value of R at H6 ,H12 ,H24 postoperatively decreased, and the value of C I prolonged （P 〈 0. 001 ） , when compared with preoperative value. The value of EPL and Ly 30 at postoperative H48 were statistically different from preoperative value（ P 〈 0.05 ）. And the D - Dimer and FDPs in- creased significantly, peaked at H6 postoperatively and lasted for 24h at least. [ Conclusion] The fibrinolysis peaked at 6h after surgery, and maintained for 24h after surgery following primary THA and TKA, as evidenced by an increase in D - dimers and FDPs.

关 键 词：关节成形术 置换 髋关节 膝关节 纤维蛋白溶解 

分 类 号：R687.4[医药卫生—骨科学]