术前血栓弹力图在不同骨科疾病间的对比及差异性分析

Comparison of preoperative thrombelastography in different orthopedics diseases and analysis of difference

目的:比较骨科不同疾病患者的术前血栓弹力图(TEG)各参数值,分析术前TEG与高凝状态和围手术期下肢深静脉血栓(DVT)的关系,探讨骨科疾病患者术前TEG检测的必要性。方法:选取骨科2015-09-2016-06收治患者266例,按疾病种类不同分为关节炎组60例、骨折组47例、坏死组79例和腰颈椎组80例共4组作为观察组。选取同期健康体检者100例作为对照组。记录各组术前TEG结果进行统计分析。结果:各观察组与对照组比较,术前TEG结果异常率均增高(P<0.05);观察组与对照组的术前TEG参数均值比较,关节炎组的K值降低,Angle角、MA值、G值增高(均P<0.05);骨折组和坏死组的R值和K值降低,Angle角、MA值、G值增高(均P<0.05)。关节炎组与骨折组的DVT发生率均比对照组、坏死组、腰颈椎组高(均P<0.05)。骨折组术前DVT患者比术后DVT患者的Angle角增大、MA延长、G增强(均P<0.05)。结论:创伤性骨折患者、骨性关节炎患者和缺血性骨坏死患者在术前处于高凝状态的比例较高,前两者围手术期DVT的发生率及其术前TEG结果异常率均增高;该3种骨科疾病患者的术前TEG检测非常必要。

Objective：To compare the preoperative values of thrombelastography （TEG） in different department of orthopedics patients,analyze the relationship between preoperative TEG and preoperative deep venous thrombosis （DVT）,andexplore the necessity of preoperative TEG examination in patients in thedepartment of orthopedics.Method：A total of 266 cases of orthopedics in our hospital from September 2015 to June 2016 were selected.According to the different disease types,the patients were divided into 4 groups as the observation group：arthritis group （60 cases）,fracture group （47 cases）,necrosis group （79 cases） and lumbar cervical group（80 cases）.One hundred healthy subjects were selected as the control group.Recorded the preoperative TEG andmade statistics.Result：The abnormal rates of TEG in the observation group were all rised compared with control group （P〈0.05）.To compared the average values of preoperative TEG parameter in the observation group with the control group,K value decreased,Angle angle,MA valueand G value rose in arthritis group （P〈0.05）.R valueand K value decreased,Angle angle,MA value and G value increased in the fracture groupand the necrosis group （P〈0.05）.The DVT incidenceof arthritis group and fracture group were higher than those of control group,necrosis group and lumbar cervical vertebrae group （P〈0.05）.The Angle angle,MA value and G value were higher （P〈0.05） in the patients with traumatic fractures whose preoperative DVT occured than those inpostoperative DVT.Conclusion：The proportion of high coagulation state was higher in patients with traumatic fractures,osteoarthritis andischemic osteonecrosis before operation.The DVT incidence in perioperative period and the abnormal rate of preoperative TEG were all rise in first two patients.The preoperative TEG detection would be necessary in the three kinds of Department of orthopedics.