充填骨水泥与人工髋关节置换后的凝血功能

Effect of bone cement on coagulation functions following artificial hip joint replacement

背景:对于人工髋关节置换的高龄患者,宜采用骨水泥固定假体,在骨水泥应用过程中,出现很多严重的并发症,但对患者凝血机制的影响报道不多。目的:观察人工关节置换过程中充填骨水泥对患者凝血功能。方法:对65例ASAⅡ-Ⅲ级人工关节置换术的患者进行回顾性病例分析,其中股骨颈骨折38例,37例股骨头坏死,术中髓腔扩髓完成后,分别在注入骨水泥前10min,注入骨水泥后30min,1,2及3h检测患者凝血功能相关指标,包括血浆凝血酶原时间、活化的部分凝血活酶时间、凝血酶时间、纤维蛋白原、及血浆D-二聚体水平,并进行统计学分析。结果与结论:血浆凝血酶原时间、纤维蛋白原、及血浆D-二聚体含量4项指标在注入骨水泥后30min、1,2h与注入骨水泥前30min相比较均有显著性差异(P<0.05)。活化的部分凝血活酶时间、凝血酶时间在各时间点与注人骨水泥前比较均无显著性差异(P>0.05)。3h后骨水泥对这些指标的影响消除,24h后凝血功能恢复正常。说明人工关节置换中充填骨水泥后3h可致患者血液高凝状态,应引起重视。

BACKGROUND：It is suitable to use bone cement to fix the prosthesis in eldly patients undergoing artificial hip joint replacement.There are many serious complications of using bone cement and little reports about the effects of bone cement on the coagulation functions of patients.OBJECTIVE：To investigate the effect of bone cement on coagulation functions during the artificial joint replacement.METHODS：Sixty-five patients scheduled for ASA Ⅱ-Ⅲ artificial joint elective replacement were investigated retrospectively.There were femoral neck fractures in 38 patients and femoral head necrosis in 37 patients.Blood samples were measured 10 minutes before and 30 minutes,1,2 and 3 hours after bone cement implantation.The parameters associated with coagulation functions were observed in all patients,including plasma prothrombin time,activated partial thromboplastin time,thrombin time,fibrinogen and D-dipolymer.RESULTS AND CONCLUSION：There were significant differences in plasma prothrombin time,fibrinogen and D-dipolymer between bone cement preimplantation and 30 minutes,1,2 hours after bone cement implantation（P 0.05）,and no difference in activated partial thromboplastin time and thrombin time（P 0.05）.The changes vanished 3 hours after bone cement implantation.The coagulation functions recovered 24 hours later.Bone cement implantated for 3 hours can cause temporal hypercoagulabale state,which should be paid more attention.