富血小板血浆对股骨头坏死保髋术后凝血相关血液指标的影响

文题释义：富血小板血浆：为自体血离心后分离所得的较高浓度血小板血浆,内含多种生长因子包括表皮生长因子、血管内皮生长因子、血小板衍生因子等。研究表明其具有促进股骨头坏死的骨形成和微血管形成的作用,是股骨头坏死的一种新型治疗方式。保髋治疗：保髋是股骨头坏死以保全患者自身股骨头为原则的治疗方法,分为非手术保髋和手术保髋。非手术保髋主要包括保护性负重、药物治疗、中医特色治疗、物理治疗;手术保髋包括髋关节镜、外科脱位、髋臼周围截骨以及打压植骨支撑、富血小板血浆治疗等。背景：研究发现富血小板血浆注射可改变股骨头坏死患者的凝血功能。目的：探讨富血小板血浆注射疗法对股骨头坏死患者保髋术后凝血指标的影响,评估术后发生血管栓塞性疾病的危险因素。方法：选择广州中医药大学第一附属医院2016年12月至2018年9月收治,采用股骨头钻孔减压、清除股骨头内死骨联合同种异体腓骨移植支撑治疗的股骨头坏死患者75例,按术中是否使用富血小板血浆注射治疗分为2组,其中富血小板血浆组42例(42髋),对照组33例(35髋)不使用富血小板血浆,2组其余治疗方法一致。连续观察2组患者术前及术后凝血4项等血液学指标的变化。结果与结论：①2组患者均连续随访3个月;②2组患者纤维蛋白酶原、D-二聚体水平均明显升高,但富血小板血浆组患者术后1周内纤维蛋白酶原、D-二聚体水平较对照组提升52.5%及47.0%,提示富血小板血浆可能导致术后高凝状态,血管栓塞风险可能较大;③2组凝血酶原时间、活化部分凝血活酶时间、国际标准化比值在数值上有明显差异,但无明显临床意义;④使用富血小板血浆对患者体内血小板水平基本无影响,对C-反应蛋白的变化亦无明显影响。ORCID: 0000-0003-3043-7775(罗智鸿)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

Effect of platelet-rich plasma on blood coagulation indexes after hip preserving surgery for osteonecrosis of the femoral head

BACKGROUND:It was found that platelet-rich plasma injection can change the coagulation function of patients with osteonecrosis of the femoral head.OBJECTIVE:To investigate the effect of platelet-rich plasma injection on coagulation parameters in patients with osteonecrosis of the femoral head after hip preserving surgery,and to evaluate the risk factors of vascular embolism after surgery.METHODS:Totally 75 cases of osteonecrosis of the femoral head treated by drilling and decompression of the femoral head,removing the dead bone in the femoral head and supporting with fibula allograft were selected in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from December 2016 to September 2018.According to whether platelet-rich plasma injection was used during the operation,the patients were divided into two groups.The platelet-rich plasma group contained 42 cases(42 hips).The control group(33 cases,35 hips)did not use platelet-rich plasma.The other treatments in the two groups were the same.The changes of blood coagulation indexes before and after operation were continuously observed in the two groups.RESULTS AND CONCLUSION:(1)Patients in both groups were followed up for 3 months.(2)Levels of fibrinogen and D-dimer were significantly increased in both groups.However,levels of fibrinogen and D-dimer in one week after operation in the platelet-rich plasma group were 52.5%and 47.0%higher than those in the control group,indicating platelet-rich plasma led to hypercoagulability and a possible high risk of vascular embolism.(3)There were significant differences in prothrombin time,activated partial thromboplastin time and international standardized ratio,but there was no significant clinical significance in both groups.(4)The use of platelet-rich plasma had no effect on platelet level or C-reactive protein.