初次创伤骨折术后和二次创伤骨折术后机体凝血状态变化的差异性研究

目的：通过比较初次骨折与二次骨折术后机体凝血状态的变化，探讨骨折手术病史对于二次骨折后机体凝血状态的影响。方法：选新西兰大免10只，5-6月龄，雌雄各半，体重2．4～2．6k，无孕。先制作初次创伤骨折术后模型，12周后再进行二次创伤骨折术后造模，分别于两次骨折术后1d、5d取静脉血测量血浆凝血酶原时间（PTT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）及D-二聚体（D—D）5个指标，比较两次骨折术后同一时间各指标的变化。结果：二次创伤骨折术后1d与初次创伤骨折术后1d比较，PT、APTT值差异无统计学意义（P〉0．05），TT、FIB、D—D值均升高，差异有统计学意义（P〈0．05）；二次创伤骨折术后5d与初次创伤骨折术后5d比较，FTT值差异无统计学意义（P〉0．05），APTT、TT、FIB、D—D值均升高，差异有统计学意义（P〈0．05）。结论：骨折手术病史使二次创伤骨折后血液更加处于高凝状态。

Differences in the changes of blood clotting state after initial trauma fractures and twice trauma fractures

Objective: To compare changes of blood clotting state after initial trauma fractures and twice trauma fractures,investigate the effect of fracture history to the state of the blood clotting after secondary trauma fractures. Methods: Thirty New Zealand rabbits were selected,aged 5-6 months,males and females unlimited,weighted 2.4-2.6 kg,non-pregnant. Postoperative model of initial trauma fractures was established,and then postoperative model after twice trauma fractures was built. Prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),fiber fibrinogen (FIB) and D-dimer (DD) were detected by venous blood at 1 day and 5 days after surgery. Changes of indicators were compared between after twice fractures at the same time. Results: Comparing with 1 day after the secondary trauma fracture and initial trauma fracture surgery,PT,APTT values showed no significant difference (P >0.05),TT,FIB,DD values were increased,and the difference was statistically significant (P<0.05); Comparing with 5 days after the secondary trauma fracture and initial trauma fracture surgery,PT values showed no significant difference(P >0.05),APTT,TT,FIB,DD values were increased,and the difference was statistically significant(P<0.05). Conclusion: Blood after the secondary trauma fractures is in hypercoagulable state after fracture surgery.