血栓弹力图与传统凝血检查监测围关节置换期的凝血状态

背景：骨科关节置换后患者处于高凝状态，容易诱发深静脉血栓得到普遍共识。血栓弹力图作为一种新型的监测凝血状态的检查工具，在骨科的临床应用较少，是否能够通过其监测关节置换围置换期患者的凝血状态，指导临床预防深静脉血栓及用药尚无定论。 目的：探讨血栓弹力图实验与常规凝血功能检查的相关性，评价血栓弹力图在监测骨科关节置换围置换期凝血状态中的应用价值。  方法：回顾性分析2014年11月至2015年8月苏州大学附属第一医院收治的关节置换患者204例，分别收集置换前、置换后血栓弹力图、血凝常规、血小板等数据。将血栓弹力图结果分别与传统的凝血检查，即凝血常规、血小板计数等结果进行相关性分析。  结果与结论：膝关节组活化部分凝血活酶时间与反应时间表现出较好的一致性(φ=0.713，Kappa值=0.647)；凝血酶原时间与反应时间有中等程度的相关性，一致性一般(φ=0.392，Kappa值=0.362)；凝集时间与纤维蛋白原有中等程度的相关性及一致性(φ=0.392，Kappa值=0.488)；凝集块形成速率(α角)与纤维蛋白原有中等程度的相关性及一致性，其余参数相关性及一致性差；而髋关节组除了反应时间与活化部分凝血活酶时间、凝血酶原时间有较弱的相关性和一致性外，其余相关性均差。但是也有部分参数的血栓弹力图与凝血常规凝血趋势一致的比例较高，髋关节组凝集时间与纤维蛋白原结论一致的比例占67.6%，凝集块形成速率(α角)与纤维蛋白原结论一致的比例占78.3%。提示血栓弹力图与常规凝血功能检查有一定相关性和一致性。血栓弹力图参数在数据上的趋向性更一致，血栓弹力图可以作为关节置换围置换期监测凝血状态的一种辅助手段。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程   

Thrombelastography and conventional coagulation test for monitoring the perioperative coagulation state after joint arthroplasty

BACKGROUND: There is a general consensus that patients undergoing joint arthroplasty surgery will be in hypercoagulable state and easily to induce deep vein thrombosis. Thromboelastography is a new kind of method to monitor blood coagulation state, but not widely used in orthopaedics. No final conclusion has yet been reached on whether we can guide the clinical prevention of deep vein thrombosis and medication through using thromboelastography to monitor perioperative coagulation state of patients treated with joint arthroplasty. OBJECTIVE: To investigate the correlation between thromboelastography and routine coagulation functional tests, and evaluate the clinical application value of thromboelastography in monitoring the perioperative coagulation state of patients treated with joint arthroplasty.   METHODS: A total of 204 patients who treated with joint arthroplasty at First Affiliated Hospital of Soochow University from November 2014 to August 2015 were retrospectively analyzed. The thromboelastography, routine coagulation, platelet and other data before and after the replacement were respectively collected. The correlative analysis was conducted between the thromboelastography result and the results of conventional coagulation test, that is, routine coagulation and platelet count. RESULTS AND CONCLUSION: In total knee arthroplasty group, activated partial thromboplastin time and reaction time showed good consistency (φ=0.713, Kappa value=0.647); Prothrombin time had moderate correlation and general consistency with reaction time (φ=0.392, Kappa value=0.362); Coagulation time and fibrinogen had moderate correlation and consistency (φ=0.392, Kappa value=0.488); Aggregates formation rate (α angle) and fibrinogen had moderate correlation and consistency; the remaining parameters had poor correlation and consistency. In total hip arthroplasty group, there was a weak correlation and consistency between the reaction time, activated partial thromboplastin time and prothrombin time; the other correlations were poor. However, there was a higher proportion of consistent clotting trend between some parameters of thrombelastography and routine coagulation. In total hip arthroplasty group, the consistent proportion of coagulation time and fibrinogen accounted for 67.6%; the consistent proportion of aggregates formation rate (α angle) and fibrinogen accounted for 78.3%. These results suggest that thromboelastography and routine coagulation tests have some correlations and consistency. Thromboelastography parameters have more consistent tendency on the data. Thrombelastography can serve as an auxiliary mean to monitor coagulation state of perioperative joint arthroplasty.