骨水泥填塞股骨髓内定位孔对全膝关节置换术后凝血状态及出血的影响

Effect of Bone Cement Sealing of Intramedullary Femoral Canal on Coagulation Status and Blood Loss after Total Knee Arthroplasty

目的探讨骨水泥填塞股骨髓内定位孔对全膝关节置换术(TKA)后凝血状态及出血的影响。方法选择2022年1月至2024年4月行首次单侧TKA的原发性膝关节骨性关节炎病人作为研究对象,根据术中密封股骨髓内定位孔的方式不同分为试验组(43例)和对照组(40例),分别给予骨水泥或自体骨密封股骨髓内定位孔。比较两组病人术后第1天、第7天的血栓弹力图(thrombelastography,TEG)指标(R值、K值、α值、MA值及CI值),出血量(总出血量、术中出血量、术后引流量、隐性出血量),输血率及深静脉血栓形成(DVT)发生率。结果术后第1天的α值、术后第1天及第7天的CI值比较,试验组显著高于对照组,差异有统计学意义(P<0.05),其余时间TEG指标的组间差异无统计学意义(P>0.05);术后总失血量及隐性失血量对比,试验组显著少于对照组,差异有统计学意义(P<0.05);两组术中出血量、术后引流量、术后输血率及DVT形成率对比,差异无统计学意义(P>0.05)。结论在TKA术中用骨水泥封堵股骨髓内定位孔可产生术后相对高凝状态,减少术后总出血量及隐性出血量,但对引流量、输血率及DVT发生率没有影响。

Objective To explore the effect of bone cement sealing of intramedullary femoral canal on coagulation status and blood loss after total knee arthroplasty(TKA).Methods Patients with primary knee osteoarthritis who underwent unilateral TKA for the first time from January 2022 to April 2024 were selected as the research subjects.According to the different methods of sealing intramedullary femoral canal during surgery,the patients were divided into experimental group(43 cases)and control group(40 cases),and were given bone cement or autogenous bone sealing of the intramedullary femoral canal,respectively.Thrombelastography(TEG)indexes(R,K,α,MA and CI),blood loss(total blood loss,intraoperative blood loss,drain blood volume,hidden blood loss),transfusion rate and DVT incidence on postoperative day 1 and postoperative day 7 were compared.Results Theαon the 1st day after operation and the CI on the 1st and 7th day after operation in the experimental group was significantly higher than in the control group(P<0.05).The rest of the TEG indexes showed no statistically significant difference between the experimental group and the control group(P>0.05).The total postoperative blood loss and hidden blood loss in the experimental group were significantly less than in the control group(P<0.05).The intraoperative blood loss and drain blood volume showed no significant difference between the experimental group and the control group(P>0.05).The transfusion rate and the rate of DVT formation had no significant difference between the experimental group and the control group(P>0.05).Conclusion Sealing the intramedullary femoral canal with bone cement during TKA produces a relative postoperative hypercoagulable state and reduces total and hidden blood loss,but has no effect on the amount of drainage,the rate of transfusion,or the incidence of DVT.