强直性脊柱炎全髋关节置换后隐性失血的危险因素分析

Risk factors for hidden blood loss after total hip arthroplasty in patients with ankylosing spondylitis

背景:全髋关节置换是治疗强直性脊柱炎累及髋关节破坏的有效措施,强直性脊柱炎患者全髋关节置换后有不同程度的贫血,而隐性失血在全髋关节置换围手术期失血量占有较大比例,影响关节功能的恢复。目的:分析强直性脊柱炎髋关节受累患者接受全髋关节置换后隐性失血的危险因素。方法:人工全髋关节置换治疗的60例(70髋)强直性脊柱炎累及髋关节的患者,平均年龄35.12岁。根据Gross方程计算隐性失血量,收集和分析手术时间、血沉、C-反应蛋白、体质量指数、是否骨质疏松、强直性脊柱炎髋关节放射指数、异体输血量等对患者全髋关节置换后隐性失血的影响,并按隐性失血量分为高隐性失血组(≥480 m L)和低隐性失血组(<480 mL),通过单因素相关分析及多因素Logistic回归分析(SPSS17.0)影响强直性脊柱炎患者初次全髋关节置换术后高隐性失血的危险因素。结果与结论:(1)患者初次全髋关节置换后隐性失血量为(737.76±419.18)mL,总失血量为(1 312.83±487.41)mL,隐性失血占总失血量的51.48%。高隐性失血组41髋,低隐性失血组29髋,比例为41∶29;(2)单因素相关分析结果显示手术时间、强直性脊柱炎髋关节放射指数、是否骨质疏松、异体输血量、血红蛋白下降量与高隐性失血显著相关;(3)多因素Logistic回归分析结果显示强直性脊柱炎髋关节放射指数、异体输血量、血红蛋白下降量与高隐性失血显著相关;(4)结果说明,隐性失血量是强直性脊柱炎患者初次全髋关节置换后总失血量的重要组成部分,强直性脊柱炎髋关节放射指数、异体输血量、血红蛋白下降量是高隐性失血的危险因素。

BACKGROUND： Total hip arthroplasty is an effective measure to treat hip involvement in ankylosing spondylitis.Ankylosing spondylitis patients have different degrees of anemia after total hip arthroplasty. The hidden blood loss accounts for a large proportion of perioperative blood loss in total hip arthroplasty, and can affect the recovery of joint function.OBJECTIVE： To investigate risk factors of hidden blood loss after total hip arthroplasty in patients with hip involvement in ankylosing spondylitis.METHODS： We studied a consecutive series of 70 hips in 60 patients with ankylosing spondylitis hip involvement who were converted to cementless total hip arthroplasty. The average age of surgery was 35.12 years. The hidden blood loss was calculated according to Cross formula linear equation. The effects of operation time, erythrocyte sedimentation rate,C-reactive protein, body mass index, Bath ankylosing spondylitis radiology index, allogenic blood transfusion, and osteoporosis on hidden blood loss after total hip arthroplasty in patients with ankylosing spondylitis were analyzed. The patients were divided into the high blood loss group （≥ 480 mL） and the low blood loss group （〈 480 mL） according to the high blood loss. Risk factors of high hidden blood loss after total hip arthroplasty in patients with ankylosing spondylitis were analyzed by single factor analysis and multivariate Logistic regression analysis （SPSS 17.0）.RESULTS AND CONCLUSION： （1） The hidden blood loss after primary total hip arthroplasty in patients with ankylosing spondylitis was （737.76＆#177;419.18） mL, and the total blood loss was （1312.83＆#177;487.41） mL, and the percentage of hidden blood loss was 51.48%. The high blood loss group included 41 hips, and the low blood loss group included 29 hips; and the ratio was 41：29. （2） Single factor analysis showed that the operation time, Bath ankylosing spondylitis radiology index and osteoporosis, allogenic blood transfusion, decrease of hemoglobin were significantly associated with high hidden blood loss. （3） Multivariate Logistic regression analysis showed that Bath ankylosing spondylitis radiology index,allogeneic blood transfusion, and decrease of hemoglobin were significantly associated with high hidden blood loss. （4）Hidden blood loss is an important portion of total blood loss after primary total hip arthroplasty in patients with ankylosing spondylitis. Bath ankylosing spondylitis radiology index, allogeneic blood transfusion and decrease of hemoglobin are risk factors for high hidden blood loss.