血栓弹力图联合D-二聚体对评估椎体强化术后血栓形成的临床意义  

Clinical significance of thromboelastography and D-dimer in the assessment of thrombosis after vertebral augmentation

作　　者：陈晓 屈一鸣[2] 徐海涛[2] 邵高海[2] Chen Xiao;Qu Yiming;Xu Haitao;Shao Gaohai(Department of Orthopedics,the First People's Hospital of Neijiang,Neijiang 641000,China;Department of Orthopedics,Yongchuan Hospital of Chongqing Medical University,Yongchuan 402160,China)

机构地区：[1]内江市第一人民医院骨科,内江641000 [2]重庆医科大学附属永川医院骨科,永川402160

出　　处：《中华老年医学杂志》2019年第5期586-590,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨血栓弹力图(TEG)联合D-二聚体(D-D)监测经皮椎体成形术(PVP)和经皮椎体球囊后凸成形术(PKP)术后凝血功能动态变化结果。方法对我院2016年5月至11月收治的52例老年骨质疏松症椎体压缩性骨折患者,男13例,年龄64~91岁,平均(74.3±10.5)岁;女39例,年龄60~89岁,平均(71.4±7.3)岁。在局部麻醉下行椎体成形术,其中PVP29例,PKP23例。所有病例均于骨水泥注入前1h、骨水泥注入后0.5h、1h、3h进行抽血检查血栓弹力图(TEG)及D-二聚体,了解其凝血功能动态变化情况。结果所有病例骨水泥注入前1h与骨水泥注入后0.5h相比较:各指标值差异均无统计学意义(均P>0.05);与骨水泥注入后1h相比较:R值、Angle角、CI值、EPL值及LY30值差异有统计学意义(均P<0.05),而K值、Ma值及D-二聚体值无统计学差异(均P>0.05);与骨水泥注入后3h相比较:R值、K值、Angle角、Ma值、CI值、LY30值及D-二聚体值差异均无统计学意义(P>0.05),仅EPL值差异有统计学意义(P<0.05)。结论PVP/PKP术后0.5~3h期间,血液处于一过性高凝状态,术后1h达峰值,血栓形成风险增加。因此,在此期间临床医师可根据患者病情使用抗凝药物等临床干预,术后严密监测凝血功能变化,且早期活动。Objective To explore changes in coagulation function, assessed by thromboelastography(TEG)combined with D-dimer(D-D), in patients undergoing percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP). Methods A total of 52 elderly patients with osteoporosis-associated vertebral compression fractures admitted into our hospital from May 2016 to November were enrolled in this study, including 13 men aged 64-91 years, with a mean age of(74.3±10.5)years, and 39 women aged 60-89 years, with a mean age of(71.4±7.3)years.Patients received vertebroplasty under local anesthesia, with 29 patients undergoing PVP and 23 cases taking PKP.Thromboelastography(TEG)and D-dimer(D-D)levels were measured at 1 h before, 0.5 h, 1 h and 3 h after bone cement injections, in order to analyze changes in patients' coagulation function. Results Compared with the coagulation parameters in patients 1 h before bone cement injections, the values of R, K, Angle, Ma, CI, EPL, LY30 and D-D had no significant difference in patients 0.5 h after bone cement injections(P>0.05);the values of R, Angle, CI, EPL and LY30 were significantly different(P<0.05), but the values of K, Ma and D-D had no significant difference(P>0.05)in patients 1 h after bone cement injections;the values of R, K, Angle, Ma, CI, LY30 and D-D had no significant difference(P>0.05), but the value of EPL was significantly different in patients 3 h after bone cement injections(P<0.05). Conclusions The blood is in a transient hypercoagulable state during the time of 0.5 h to 3 h after PVP or PKP, which reaches the peak at the time of 1 h after operation, thereby increasing the risk of thrombosis.Therefore, some interventions such as anticoagulants could be carried out during the preoperative and postoperative period.Changes in coagulation function should be closely monitored after operation.Patients should start postoperative exercise early.

关 键 词：骨折 D-二聚体 椎体成形术 血栓形成 

分 类 号：R687.3[医药卫生—骨科学]