血栓弹力图评价膝关节类风湿与骨性关节炎关节置换术后凝血功能

目的:利用血栓弹力图(thromboelastography,TEG)评价膝关节类风湿性关节炎(rheumatoid arthritis,RA)与骨性关节炎(osteoarthritis,OA)患者行全膝关节置换( total knee arthroplasty,TKA)术后凝血功能改变,并分析两者的凝血功能及D-二聚体(D-dimer)值差异,从而明确RA是否增加TKA术后深静脉血栓( deep vein thrombosis,DVT)形成风险.方法: 对行初次TKA术的126例患者进行前瞻性研究,其中RA患者42例,OA患者84例.所有患者术后12 h开始使用10 mg利伐沙班抗凝治疗,术前检测D-dimer,并于术后第1、3、5、7天行TEG及D-dimer检查.比较两组患者在不同时间高凝患者比例及D-dimer值差异,并分析原因.结果: OA患者术后第3天高凝状态患者比例较第1天降低,第3~7天高凝状态患者比例逐渐增加;而RA患者术后高凝状态患者比例逐渐降低,两组比较差异无统计学意义(P＞0. 05). RA患者术前D-dimer值高于OA患者,差异有统计学意义(P=0. 001),术后两组患者D-dimer值均先升高而后下降,不同时间比较差异无统计学意义(P＞0. 05).结论: RA与OA患者TKA术后高凝患者比例无明显差异,TKA术后DVT发生率在两者中相似.

Thromboelastography evaluation of coagulation function after total knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis

Objective:To evaluate the coagulation status of patients undergoing total knee arthroplasty ( TKA) in patients with rheumatoid arthritis (RA) and osteoarthritis(OA) with thromboelastography (TEG). And to analyze the difference of coagulation statue and D-dimer value,so as to determine whether RA increase the risk of deep vein thrombosis (DVT) after TKA. Methods:A prospective study was conducted on 126 patients with primary TKA,including 42 patients with RA and 84 patients with OA. All patients began to use 10 mg of rivaroxaban orally at 12 h after operation. The D-dimer was detected before operation,and TEG and D-dimer were exam-ined in the 1,3,5 and 7 d after surgery. The proportion of patients with high coagulation and D-dimer value were compared between the two groups,and the reasons were analyzed. Results:In OA patients,the proportion of patients with hypercoagulant state on the 3 day was lower than that of the 1 day after surgery,but it increased gradually during the 3-7 days. In RA patients,the proportion of patients with hypercoagulability decreased gradually after surgery,there were no statistically significant differences between the two groups ( P ＞0. 05). Preoperative D-dimer value of RA patients was higher than that of OA patients (P=0. 001). After the operation,the D-dime values of both groups were increased first and then decreased,and there was no statistical significance in the difference of time ( P＞0. 05). Conclusion:There is no significant difference in the proportion of patients with hypercoagulant state after TKA in RA and OA patients,and the incidence of DVT is similar in the two groups.