血友病合并骨折围手术期凝血因子替代治疗

Therapy of perioperative coagulation factor replacement in patients having fracture with hemophilia

目的探讨血友病合并骨折围手术期凝血因子替代治疗方法与安全性。方法 5例合并骨折的血友病患者在血液内科的配合下,对患者实施手术治疗骨折,平均随访9个月。根据《血友病诊断与治疗中国专家共识》,围术期行凝血因子Ⅷ和Ⅸ活性水平监测,进行因子Ⅷ(冻干人凝血因子Ⅷ)或因子Ⅸ(凝血酶原复合物)的替代治疗。结果本组5例血友病患者,围手术期应用凝血因子进行常规替代治疗,均安全度过围手术期,术中、术后无血肿、感染。但有一例股骨干骨折钢板固定后术后4个月再次骨折,经保守治疗骨愈合。结论凝血因子的替代治疗和凝血因子水平监测是保证血友病合并骨折手术治疗成功的关键。

Objective To study the method and safety of coagulation factor replacement in patients having fracture with hemophilia. Methods Five male hemophilia patients with fractures were treated, and the mean follow-up period was 9 months. Under the cooperation with the hematology department. Monitored levels of factors Ⅷand IX perioperatively, and established routine process of factor replacement, according to the China guideline of Hemophilia dialogue and treatment. Results Hemophilic patients who had undergone therapy of perioperative coagulation factor replacement could suffer treatment of fractures. All patients had no complications such as hematoma, infection. But one patient firstly accepted operation, after 4months, the plate was broken, proformed conservative treatment. Conclusion Coagulation factor replacement and monitoring of coagulation factor levels are the key to the success of treament in hemophilic fracture patients.