骨水泥假体在老年THA手术中的应用效果及对凝血功能的影响

目的探讨老年全髋关节置换术(THA)患者应用骨水泥假体的手术效果及对患者凝血功能变化的影响。方法回顾性分析2014年1月—2016年12月珠海市人民医院行THA手术治疗的256例老年患者临床资料,其中128例采用骨水泥型假体(骨水泥组)、128例采用非骨水泥型假体植入(非骨水泥组),对比两组的手术指标、术后髋关节功能指标、凝血相关指标。结果骨水泥组患者的手术时间(130.6±19.4)min长于非骨水泥组(103.2±15.8)min(P0.05);骨水泥组和非骨水泥组患者的术中出血量、住院时间比较差异无统计学意义(P0.05);术后1、3、6个月,骨水泥组Harris功能评分(45.2±11.6)、(71.8±9.2)、(83.1±7.4)]分,非骨水泥组(47.0±13.4)、(73.0±10.8)、(84.8±9.5)]分,两组比较差异均无统计学意义(P0.05);术后1、3、6个月两组患者的Harris功能评分均呈显著的升高趋势;术前,骨水泥组和非骨水泥组的PTA、APTT、Fib、R值、k值、α角组间比较差异均无统计学意义(P0.05);假体植入30min,骨水泥组患者的PTA(82.9±4.7)%、Fib(3.59±0.31)g/L、α角(73.0±12.1)°均显著高于非骨水泥组的PTA(79.4±4.4)%、Fib(3.10±0.28)g/L、α角(67.2±11.6)°(P0.05),骨水泥组的APTT(33.3±3.9)s、R值(4.04±0.69)min、k值(1.47±0.09)min小于非骨水泥组的APTT(36.8±4.1)s、R值(4.98±0.87)min、k值(1.61±0.12)min(P0.05);术后3h,骨水泥组和非骨水泥组的PTA、APTT、Fib、R值、k值、α角组间比较差异均无统计学意义(PP0.05)。两组患者的手术并发症发生率比较差异无统计学意义(P0.05)。结论老年THA手术患者应用骨水泥假体植入治疗,术后髋关节功能与非骨水泥假体无差别,但是骨水泥假体植入后3h内患者发生高凝的风险增加,需要密切监视患者的凝血功能变化。

Application of bone cement prosthesis in elderly patients undergoing THA surgery and analysis of coagulation function

Objective To investigate the effect of bone cement prosthesis on the changes of blood coagula -tion function in elderly patients undergoing total hip replacement(THA).Methods Data of 256 elderly patients in our hospital for surgical treatment of THA(Jan.2014 to Dec.2016)were analyzed retrospectively,including 128 patients with bone cement prosthesis(group A),and 128 patients with cementless prosthesis(group B).Operation index,postoperative hip function index and blood coagulation index were compared between the two groups.Results The operation time of group A was(130.6 ±19.4)minutes,longer than that of group B(103.2 ±15.8)minutes (P<0.05).There was no significant difference in intraoperative blood loss and length of stay between group A and group B(P>0.05).At 1 month,3 months,and 6 months after surgery,Harris functional scores in group A was (45.2 ±11.6),(71.8 ±9.2),(83.1 ±7.4)points,respectively,and in group B was(47.0 ±13.4),(73.0 ± 10.8)and(84.8 ±9.5)points,respectively,without significant difference between the two groups(P>0.05).The Harris functional scores showed a significant increase trend at 1 month after surgery,3 months after operation,and 6 months after operation.Preoperatively,there was no significant difference in PTA,APTT,Fib,R,k,and alpha angles between group A and group B(P>0.05).At 30 minutes after implantation,the PTA(82.9 ±4.7)%,Fib(3.59 ±0.31)g/L,and αangle(73.0 ±12.1)°were significantly higher in group A than in group B(79.4 ±4.4)%,Fib (3.10 ±0.28)g/L,α(67.2 ±11.6)°(P<0.05).The APTT(33.3 ±3.9)s,R value(4.04 ±0.69)min,and k value(1.47 ±0.09)min in group A were less than the APTT(36.8 ±4.1)s,R value(4.98 ±0.87)and k value (1.61+0.12)min in group B(P<0.05);at 3 h after surgery,there was no statistical difference in PTA,APTT, Fib,R,k,and αangle groups between group A and group B(P>0.05).There was no significant difference in the rate of surgical complications between the two groups(P>0.05).Conclusion There is no difference in hip func-tion and cementless prosthesis after cement implantation in elderly patients with THA surgery.However,the risk of hypercoagulability increases within 3 hours after implantation of cemented prosthesis.Close monitoring is required for coagulation function changes.