| 血友病性关节炎关节置换术后个性化预防血栓治疗的临床观察 |
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投稿时间：2014-12-26
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| 作者 | Author | 单位 | Address | E-Mail |
| 潘佳飞 |
PAN Jia-fei |
萧山医院, 浙江杭州 311202 |
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| 储小兵 |
CHU Xiao-bing |
浙江省中医院骨伤科, 浙江杭州 310006 |
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| 庄汝杰 |
ZHUANG Ru-jie |
浙江省中医院骨伤科, 浙江杭州 310006 |
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| 周莉 |
ZHOU Li |
浙江中医药大学, 浙江杭州 310053
浙江省骨伤研究所, 浙江杭州 310053 |
Orthopaedics Academy of Zhejiang, Hangzhou 310053, Zhejiang, China |
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| 金红婷 |
JIN Hong-ting |
浙江中医药大学, 浙江杭州 310053
浙江省骨伤研究所, 浙江杭州 310053 |
Orthopaedics Academy of Zhejiang, Hangzhou 310053, Zhejiang, China |
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| 吴承亮 |
WU Cheng-liang |
浙江中医药大学, 浙江杭州 310053 |
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| 肖鲁伟 |
XIAO Lu-wei |
浙江中医药大学, 浙江杭州 310053
浙江省骨伤研究所, 浙江杭州 310053 |
Orthopaedics Academy of Zhejiang, Hangzhou 310053, Zhejiang, China |
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| 童培建 |
TONG Pei-jian |
浙江省中医院骨伤科, 浙江杭州 310006
浙江中医药大学, 浙江杭州 310053
浙江省骨伤研究所, 浙江杭州 310053 |
Orthopaedics Academy of Zhejiang, Hangzhou 310053, Zhejiang, China |
tongpeijian@163.com |
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| 期刊信息：《中国骨伤》2015年，第28卷，第3期，第268-271页 |
| DOI：10.3969/j.issn.1003-0034.2015.03.017 |
| 基金项目: |
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中文摘要:
目的:观察血友病性关节炎关节置换术后个性化预防血栓治疗的临床意义。
方法:自2005年9月至2013年10月,11例甲型血友病性关节炎患者行关节置换术,共手术14次,其中包括1例双膝计1次,左膝6次,右膝5次,髋关节2次。11例均为男性,年龄23～57岁,平均(36.1±11.0)岁,平均体重(64.1±8.9) kg.术前结合影像学和实验室检查准确诊断和分型,评估关节功能和术后静脉血栓栓塞出现的风险,围手术期动态监测患者FactorⅧ∶C、血常规和凝血功能。结合术前风险评估,术后根据检测结果个性化调整替代药物重组人凝血因子Ⅷ(拜科奇)剂量进行预防血栓治疗,观察患者血栓发病率。同时将患者分为术后远端关节活动组和非活动组,观察记录两组患者的凝血类各项指标和出院时间。
结果:根据术后FactorⅧ∶C,凝血类和血常规检查动态调整替代疗法预防血栓,纳入研究11例均未发生术后深静脉血栓或肺栓塞。早期指导肢体远端关节活动患者术后短期内APTT高于非活动组,D-2聚体低于非活动组,术后出院时间短于非活动组。
结论:血友病性关节炎关节置换术后由于自身凝血功能障碍易发生出血,但并不意味着此类患者无术后血栓形成风险,根据动态检测调整替代药物剂量,完成个性化术后预防血栓、止血和凝血因子代替治疗的平衡,同时配合术后肢体远端功能,可以大大降低血栓风险,并且缩短出院时间。 |
| 【关键词】血友病A 血栓栓塞 关节成形术,置换 |
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| Clinical experience on postoperative balance of hemostasis and antithrombus for patients with hemophilic arthritis after arthroplasty |
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ABSTRACT
Objective:To observe the clinical significance of postoperative personalized antithrombotic therapy for patients with hemophilic arthritis(HA) patients after arthroplasty.
Methods:From September 2005 to October 2013,11 cases of arthroplasty for hemophilic arthritis in hip and knee total operation 14 times,including 1 case of double knees(calculated as one operation),operation in left knees 6 times,operation in right knees 5 times,2 in hip. All the patients were male and the age ranged from 23 to 57 years old,with an average of (36.1±11.0) years old; the average weight was (64.1±8.9) kg. All the patients were preoperatively diagnosed and classified as hemophilic arthritis with the radiological images and laboratory tests. According to the function of joints,the risk of postoperative venous thromboembolism (VTE),and dynamic observation of Factor Ⅷ:C (FⅧ:C) activity,patients were treated with personalized antithrombus by adjusting the dosage of recombinant human coagulation factor Ⅷ (Kogenate FS). All the patients were orderly divided into postoperatively distal joints moving group and none-moving group to observe the coagulation function.
Results:The enrolled patients had no postoperative complication of VTE and pulmonary embolism (PE). The APTT and D-2 were different between two groups in the postoperative early stage. Length of hospital day was shorter in the moving group than none-moving group.
Conclusion:Because of the self-coagulation disorder,patients with HA tended to bleed. However it doesn't mean that there is no risk of postoperative thrombosis. Therefore,it's important to determine how to control the balance between postoperative antithrombus,hemostasis,and coagulation factor replacement therapy after arthroplasty for HA. Postoperative moving has proved helpful for HA,especially in reducing the risk of hemostasis and shortening the time in hospital. |
| KEY WORDS Hemophilia A Thromboembolism Arthroplasty,replacement |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 潘佳飞,储小兵,庄汝杰,周莉,金红婷,吴承亮,肖鲁伟,童培建.血友病性关节炎关节置换术后个性化预防血栓治疗的临床观察[J].中国骨伤,2015,28(3):268~271 |
| 英文格式: | PAN Jia-fei,CHU Xiao-bing,ZHUANG Ru-jie,ZHOU Li,JIN Hong-ting,WU Cheng-liang,XIAO Lu-wei,TONG Pei-jian.Clinical experience on postoperative balance of hemostasis and antithrombus for patients with hemophilic arthritis after arthroplasty[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(3):268~271 |
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