骨质疏松程度对甲型血友病性关节炎全膝置换术失血量的影响  

Effect of osteoporosis on blood loss in total knee replacement for type A Hemophilic arthritis

作　　者：王彭禾 吴佳燕 朱广平[1] 沈佳怡 陈佳丽 金红婷 童培建[3] Wang Penghe

机构地区：[1]浙江省平湖市中医院,314200 [2]浙江中医药大学第一临床医学院,310053 [3]浙江中医药大学附属第一医院,310006

出　　处：《浙江临床医学》2023年第8期1124-1126,共3页Zhejiang Clinical Medical Journal

基　　金：国家自然科学基金资助项目(81873324);浙江省自然科学基金青年项目(LQ22H270006)。

摘　　要：目的比较分析骨质疏松程度对晚期甲型血友病性关节炎(HA)一期单侧全膝关节置换术后早期失血量的影响。方法回顾性分析自2018年1月至2021年6月浙江中医药大学附属第一医院骨伤中心收治的行初次单侧全膝关节置换术(TKA)的47例晚期甲型HA患者,术前常规行骨密度及骨代谢检查,根据骨质疏松程度分为骨量正常组、骨量减少组、骨质疏松组。观察三组患者TKA围手术期一般资料及术后总失血量、术中失血量、显性失血量、隐性失血量、最大血红蛋白丢失量、输血率等,并进行统计分析。结果骨质疏松组总失血量、隐性失血量、最大血红蛋白丢失量明显大于骨量减少组和骨量正常组(P<0.05);骨量减少组和骨质疏松组显性失血量明显大于骨量正常组(P<0.05);三组术中失血量、输血率、术后住院天数比较无明显差异(P>0.05)。结论骨质疏松程度越重的HA患者的TKA术后早期的失血量更多,需加强抗骨质疏松治疗。Objective To compare and analyze the effect of osteoporosis degree on early blood loss after primary unilateral total knee arthroplasty(TKA)in advanced hemophilic arthritis(HA).Methods A retrospective analysis of 47 patients with advanced type A HA who underwent primary unilateral total knee arthroplasty(TKA)from January 2018 to June 2021 in the Orthopedic Center of the First Affiliated Hospital of Zhejiang Chinese Medical University.Routine preoperative bone mineral density and bone metabolism examinations were performed.According to the degree of osteoporosis,they were divided into the normal bone mass group(n=14),the osteopenia group(n=21),and osteoporosis group(n=21).The perioperative general data of TKA,total postoperative blood loss,intraoperative blood loss,dominant blood loss,hidden blood loss,maximum hemoglobin loss and blood transfusion rate during hospitalization were observed in the three groups of patients.Finally,the statistical analysis was performed.Results The total blood loss,hidden blood loss and maximum hemoglobin loss in the osteoporosis group were significantly greater than those in the osteopenia group and the normal bone mass group(P<0.05).The dominant blood loss in the osteopenia group and osteoporosis group was significantly greater than that in the normal bone mass group(P<0.05).There were no major complications such as hematoma,infection,lower extremity deep vein thrombosis and joint prosthesis loosening in the three groups during hospitalization.Conclusion The more osteoporosis HA patients have,the more blood loss in the early stage after TKA,so antiosteoporosis treatment should be strengthened.

关 键 词：骨质疏松 血友病性关节炎 全膝关节置换术 总失血量 隐性失血量 显性失血量 

分 类 号：R684.3[医药卫生—骨科学]