老年患者髋膝关节置换术后抗凝治疗对骨代谢和骨关节功能的影响  

The effect of anticoagulant therapy on bone metabolism and joint function in elderly patients undergoing hip and knee replacement

作　　者：胡文林[1] 朱建祥[1] 夏增兵[1] HU Wenlin;ZHU Jianxiang;XIA Zengbing(Department of Orthopedics,the First People’s Hospital of Huzhou,First Affiliated Hospital of Huzhou University,Zhejiang,Huzhou 313000,China)

机构地区：[1]湖州市第一人民医院湖州师范学院附属第一医院骨科,浙江湖州313000

出　　处：《中国现代医生》2022年第28期46-49,共4页China Modern Doctor

基　　金：湖州市科技局公益性应用研究项目(2017GYB06)。

摘　　要：目的 探究老年患者髋膝关节置换术后抗凝治疗对骨代谢和骨关节功能的影响。方法 选取2018年1月至2019年1月于湖州市第一人民医院行髋膝关节置换的60例老年患者纳入研究,依据随机数字表法将其分为对照组和观察组,每组各30例。对照组患者予依诺肝素抗凝治疗,观察组患者予利伐沙班口服抗凝治疗,比较两组患者治疗前后的骨代谢指标和骨关节功能变化。结果 治疗后14d、35d和术后3个月,两组患者的Ⅰ型胶原羧基端肽β特殊序列(β isomer of C-terminal telopeptide of typeⅠcollagen,β-CTX)均显著高于本组术前(P<0.05),治疗后14d、35d,两组患者的骨钙素(osteocalcin,OCN)均显著低于本组术前(P<0.05),两组患者术后3个月的骨碱性磷酸酶(alkaline phosphatase,ALP)均显著低于本组术前(P<0.05)。治疗14d、35d和术后3个月,观察组患者的OCN均显著高于对照组(P<0.05),β-CTX均显著低于对照组(P<0.05)。治疗14d、35d和术后3个月,两组患者的ALP比较差异均无统计学意义(P>0.05)。治疗35d和术后3个月,观察组患者的Harris髋关节评分和美国特种外科医院评分均显著高于对照组(P<0.05)。结论 老年患者髋膝关节置换术后使用低分子肝素和Ⅹa因子抑制剂进行抗凝治疗可影响患者骨代谢水平,但利伐沙班的影响相对较小。与低分子肝素相比,在关节置换抗凝治疗后期,利伐沙班更有利于老年关节置换术后的关节功能恢复。Objective To explore the effect of anticoagulation therapy on bone metabolism and joint function in elderly patients undergoing hip and knee replacement. Methods Sixty elderly patients who underwent hip and knee replacement in the First People’s Hospital of Huzhou from January 2018 to January 2019 were selected into the study.According to the random number table method, they were divided into control group and observation group with 30cases in each group. Patients in control group were treated with enoxaparin anticoagulation. Patients in observation group were given rivaroxaban oral anticoagulation therapy. The changes of bone metabolism indexes and bone and joint function were compared between the two groups before and after treatment. Results At 14 days and 35 days after treatment and 3 months after operation, the β isomer of C-terminal telopeptide of typeⅠcollagen(β-CTX) of the two groups were significantly higher than that of the group before operation(P<0.05). At 14 days and 35 days after treatment, the osteocalcin(OCN) of the two groups were significantly lower than that of the group before operation(P<0.05). The alkaline phosphatase(ALP) of the two groups at 3 months after operation was significantly lower than that of the group before operation(P<0.05). At 14 days and 35 days after treatment and 3 months after operation, the OCN of observation group was significantly higher than that of control group(P<0.05), and the β-CTX was significantly lower than that of control group(P<0.05). There was no significant difference in ALP between the two groups after treatment for 14 days and 35 days and 3 months after operation(P>0.05). The Harris hip score and hospital for special surgery score in observation group were significantly higher than those in control group at 35days and 3 months after operation(P>0.05). Conclusion Anticoagulant therapy with low molecular weight heparin and factor Ⅹa inhibitor in elderly patients after hip and knee arthroplasty can affect bone metabolism, but rivaroxaban has relati

关 键 词：抗凝治疗 髋膝关节置换 老年 骨代谢 骨关节功能 

分 类 号：R684[医药卫生—骨科学]