单髁与全膝关节置换术治疗膝单间室骨性关节炎对患者围手术期凝血指标及失血量的影响  

Effects of UKA and TKA on perioperative coagulation indexes and blood loss in patients with knee single compartment osteoarthritis

作　　者：杨天翔 张晋宁 张博文  程萌旗[3] 陈德胜 YANG Tianxiang;ZHANG Jinning;ZHANG Bowen;Muhammad Saad;CHENG Mengqi;CHEN Desheng(School of Clinical Medicine,Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学临床医学院,宁夏银川750004 [2]宁夏医科大学国际教育学院,宁夏银川750004 [3]上海交通大学附属第六人民医院关节外科,上海200233 [4]宁夏回族自治区人民医院骨科,宁夏银川750002

出　　处：《陕西医学杂志》2022年第6期684-687,691,共5页Shaanxi Medical Journal

基　　金：国家自然科学基金资助项目(81760405,81760395,82060408);宁夏回族自治区重点研发计划项目(2021BEG03049);宁夏留学人员创新创业项目(2020-75);宁夏回族自治区自然科学基金资助重点项目(2018AAC02013);宁夏医科大学校级课题重点项目(XZ2018014);宁夏高等学校一流学科建设资助项目(NXYLXK2017A05)。

摘　　要：目的:研究单髁膝关节置换术(UKA)与全膝关节置换术(TKA)治疗膝单间室骨性关节炎对患者围手术期凝血指标及失血量的影响。方法:回顾性分析因膝关节单间室骨性关节炎行单侧人工膝关节置换术的77例患者的临床资料。依据手术方式不同将患者分为UKA组(28例)和TKA组(49例)。检测并记录两组患者围术期凝血相关指标及围手术期失血量。记录围手术期下肢深静脉血栓(DVT)及肺栓塞发生情况。结果:两组患者术前D-二聚体、纤维蛋白原(FBG)水平比较差异无统计学意义(均P>0.05),但UKA组术后1 d、手术前后差值及比值低于TKA组(均P<0.05)。两组患者手术前后PT、TT、APTT、INR水平比较,差异无统计学意义(均P>0.05)。两组患者术前红细胞压积(Hct)及血红蛋白(Hb)水平比较差异无统计学意义(均P>0.05),但TKA组术后1、3 d低于UKA组(均P<0.05)。UKA组总失血量、隐性失血量及显性失血量少于TKA组(均P<0.05)。UKA组DVT发生率低于TKA组(P<0.05)。结论:UKA治疗膝关节单间室骨性关节炎,可减少围手术期对患者血液系统的影响,降低失血量及DVT发生率。Objective:To study the effects of unicondylar knee arthroplasty(UKA)and total knee arthroplasty(TKA)on perioperative coagulation indexes and blood loss in patients with knee single compartment osteoarthritis.Methods:The clinical data of 77 patients who underwent unilateral total knee arthroplasty for knee single compartment osteoarthritis were retrospectively analyzed.Patients were divided into UKA group(28 cases)and TKA group(49 cases)according to different surgical methods.Perioperative coagulation-related indexes and perioperative blood loss were detected and recorded in the two groups.Deep vein thrombosis(DVT)of lower limbs and pulmonary embolism were recorded during perioperative period.Results:There was no significant difference in the levels of D-dimer and fibrinogen(FBG)between the two groups before and after operation(all P>0.05),but the levels on the first day after operation,the differences and ratios before and after the operation in UKA group were lower than those in TKA group(all P<0.05).There was no significant difference in PT,TT,APTT and INR levels before and after operation between the two groups(all P>0.05).There was no significant difference in hematocrit(Hct)and hemoglobin(Hb)levels before operation between the two groups(all P>0.05),but TKA group was lower than UKA group 1 and 3 days after operation(all P<0.05).Total blood loss,hidden blood loss and dominant blood loss in UKA group were less than those in TKA group(all P<0.05).The incidence of DVT in UKA group was lower than that in TKA group(P<0.05).Conclusion:In the treatment of knee single compartment osteoarthritis,UKA can reduce the influence of perioperative period on the blood system,reduce blood loss and the incidence of DVT.

关 键 词：膝骨性关节炎 单髁膝关节置换术 全膝关节置换术 围手术期 凝血指标 失血量 

分 类 号：R684.3[医药卫生—骨科学]