膝关节置换中应用骨水泥和止血带对凝血功能的影响

背景：有研究表明膝关节置换中骨水泥固定假体时骨水泥对患者的血液动力学及凝血功能的影响较大。目的：观察膝关节置换中骨水泥和止血带对患者凝血功能的影响。方法：采用随机对照研究方法，将骨性关节行单侧膝关节置换患者40例随机分成2组，置换时分别应用止血带和不用止血带。通过比较两组患者血浆凝血酶原时间、活化的部分凝血活酶时间、凝血酶时间、纤维蛋白原及血浆D-二聚体水平的变化，来观察膝关节置换中骨水泥和止血带对置换中凝血功能的影响。结果与结论：两组患者在骨水泥置入后60，120 min，血浆凝血酶原时间值缩短(P < 0.05)，纤维蛋白原和D-二聚体在注入骨水泥后增多(P < 0.05)，其中止血带组的变化更为明显，两组患者在180 min时基本恢复正常，活化的部分凝血活酶时间及凝血酶时间在骨水泥注入前后均无明显变化，另外，所监测的凝血功能相关指标(血浆凝血酶原时间、活化部分凝血酶原时间、凝血酶时间、纤维蛋白原及D-二聚体的数值在注入骨水泥前后均在正常范围内。相比非止血带组，止血带组血浆凝血酶原时间缩短、纤维蛋白原及D-二聚体含量增多(P < 0.05)。说明膝关节置换中骨水泥应用后可以使单侧膝关节置换患者的凝血功能处于高凝状态，止血带可加重患者的高凝状态。

Effects of bone cement and tourniquet on coagulation function during total knee arthroplasty

BACKGROUND:Studies have shown that bone cement has a great effect on the patient's hemodynamic and blood coagulation during total knee arthroplasty.OBJECTIVE:To observe the effects of bone cement and tourniquet on coagulation function during total knee arthroplasty.METHODS:Forty osteoarthritis patients who underwent single total knee arthroplasty were randomly divided into two groups with randomized control study method: the application of tourniquet and patients who did not have tourniquet. The relative parameters were observed in all patients, including prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen and D-dipolymer. Coagulation function changes between two groups were compared.RESULTS AND CONCLUSION:The prothrombin time was significantly decreased at 60 and 120 minutes after cement implantation (P < 0.05), and the levels of fibrinogen and D-dipolymer were increased after implantation in all patients (P < 0.05), especially in the patients who use of tourniquet. The changes vanished at 180 minutes after bone cement implantation. There was no significant difference in activated partial thromboplastin time and prothrombin time before and after bone cement implantation. The values of prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen and D-dipolymer were within the normal range. Compared with the patients who did not have tourniquet, the prothrombin time in the patients with tourniquet was shortened and the fibrinogen and D-dipolymer were increased (P < 0.05). The bone cement implantation can lead to temporal hypercoagulabale state during single total knee arthroplasty, and the tourniquet can aggravate the hypercoagulable state in patients.