乙型血友病性肩关节炎肱骨头坏死置换治疗1例

Humeral head replacement in a hemophilia B omarthritis patient

背景:过去对乙型血友病性关节炎的手术治疗多面临手术难度大、术中出血难以估计、创面愈合困难等情况。而在围手术期间将患者凝血Ⅸ因子活性控制在安全范围时,可保证手术的安全进行,创面愈合好,康复情况佳,远期未见明显并发症。目的:探讨乙型血友病性肩关节炎行肱骨头置换的围手术期诊治要点,分析对预后及康复的重要性。方法:通过文献复习,总结乙型血友病性关节炎行外科治疗的意义及围手术期并发症的防治处理。对1例乙型血友病性肩关节炎诊断后,在监控凝血因子活性,输注人凝血酶原复合物及冰冻血浆的条件下行肱骨头置换治疗。结果与结论:(1)通过监控治疗,患者在凝血Ⅸ因子活性由7%上升到50%的情况下接受肱骨头置换手术;(2)置换后3 d内将凝血Ⅸ因子控制在>30%,3 d至2周内控制在>20%时,术后未见明显并发症;(3)结果提示,乙型血友病性关节炎行外科治疗较常见,对其病情评估及处理十分重要。肱骨头置换围手术期采用人凝血酶原复合物替代治疗,将凝血因子活性控制于适宜范围,可有效预防患者置换后并发症的发生。

BACKGROUND： In the past, the surgical treatment of patients with hemophilia B was difficult, the bleeding was difficult to estimate, and the wound healing was difficult. In the perioperative period, the control of coagulation factor IX activity in a safe range can ensure the safety of the operation, resulting in well wound healing, good recovery, and no significant complications appeared in the long term. OBJECTIVE： To study essentials of perioperative diagnosis and treatment in omarthritis patients with hemophilia B undergoing humeral head replacement, and to analyze the importance on prognosis and rehabilitation. METHODS： The significance of surgical treatment for hemophilia B patients with arthritis, the prevention and treatment of perioperative complications were summarized through literature review. Humeral head replacement was conducted in a patient with hemophilia omarthritis by monitoring coagulation factor activity and infusing human prothrombin complex and frozen plasma. RESULTS AND CONCLUSION： （1） According to the monitoring, patients, whose coagulation factor IX activity increased from 7% to 50%, underwent humeral head replacement. （2） Within three days after replacement, coagulation factor IX activity was controlled 〉 30%, 3 days-2 weeks 〉 20%. No obvious complication was found after surgery. （3） These results suggested that hemophilia B arthritis was commonly treated by surgical treatment, which plays an important role in assessing patient＇s condition and treatment. During perioperative period, replacement therapy of human prothrombin complex and control of coagulation factor activity in a appropriate range can effectively prevent postoperative complications.