强直性脊柱炎患者人工关节置换术后深静脉血栓预防方案的研究

发布时间：2018-05-25 21:17

本文选题：强直性脊柱炎 + 人工髋关节置换术　；参考：《中国人民解放军医学院》2015年博士论文

【摘要】：目的强直性脊柱炎是一种炎性免疫性疾病,常会导致严重的髋关节功能障碍。而人工全髋关节置换术是一种改善患者生活质量的择期性手术。而对于已经出现髋关节强直的患者手术能够解除髋关节强直症状,增加髋关节活动范围,改善行走功能障碍。深静脉血栓形成常被认为人工关节置换术的严重并发症。根据美国骨科医师学会、美国胸科医师学会及中华医学会发布的静脉血栓栓塞性疾病预防指南,不同疾病不同患者同用一套推荐方案。本研究旨在比较强直性脊拄炎患者人工关节置换术后深静脉血栓预防采用的不同方案,为不同疾病种类、不同患者提供个性化的抗凝方案。第一部分材料及方法我们选择从2009年1月至2011年1月之间在我院进行人工全髋关节置换术的患者进行回顾性研究,并将患者分为股骨头坏死患者组及强直性脊柱炎患者组。分析比较两组之间的患者人口统计学基线数据、静脉血栓栓塞发生率、D-二聚体、术中失血量以及按抗栓指南的输血量等数据。结果强直性脊柱炎患者组深静脉血栓的发生率低于股骨头坏死组。强直性脊柱炎患者组更年轻(P0.0001),而且体重指数更低(P=0.0036)。强直性脊柱炎患者的高血压(P0.0001)、糖尿病患病率较低(P=0.0385)。凝血功能(APTT,PT,及INR)的值均高于股骨头坏死组(P0.0001)。强直性脊柱炎患者失血量及输血量较股骨头坏死组高(P0.0001)。结论1.强直性脊柱炎患者静脉血栓栓塞的发病率要比股骨头坏死患者低。2.关节置换术后使用和股骨头坏死患者相同的抗凝方案强直性脊柱炎患者失血量及输血量增加。第二部分材料及方法我们选择从从2009年1月至2011年1月以及2013年1月至2015年1月之间在我院进行人工全髋关节置换术的强直性脊柱炎患者进行回顾性研究,并将患者分为常规抗凝组、个性化弱抗凝组及个性化不抗凝组。分析比较三组之间的患者人口统计学基线数据、静脉血栓栓塞发生率、D-二聚体、术中失血量以及输血量等数据。结果三组的静脉血栓栓塞发生率差别无统计学意义。个性化抗凝组输血量较常规抗凝组为低(P0.0001)。弱抗凝组和不抗凝组的失血量差别无统计学意义。结论使用个性化抗凝方案的髋关节置换术后强直性脊柱炎患者输血量较常规指南组降低,且静脉血栓栓塞发生率无统计学意义。
[Abstract]:Objective ankylosing spondylitis is an inflammatory immune disease that often leads to severe hip dysfunction. Total hip replacement is a selective procedure to improve the quality of life of patients. For the patients with hip ankylosis, the operation can relieve the symptoms of hip ankylosis, increase the range of hip motion and improve walking dysfunction. Deep venous thrombosis is often considered a serious complication of artificial joint replacement. According to the guidelines for the prevention of venous thromboembolism issued by the American College of Orthopaedic Physicians, the American College of chest Physicians and the Chinese Medical Association, different patients with different diseases use the same set of recommended programs. The purpose of this study was to compare the different prophylaxis of deep vein thrombosis in patients with ankylosing spinal column by artificial arthroplasty, and to provide individualized anticoagulant regimen for different diseases and patients. The first part of the materials and methods We selected from January 2009 to January 2011 patients undergoing total hip replacement in our hospital for a retrospective study and the patients were divided into the femoral head necrosis group and ankylosing spondylitis group. The baseline data of the two groups, the incidence of venous thromboembolism and D-dimer, the blood loss during operation and the blood transfusion according to the antithrombotic guidelines were analyzed and compared between the two groups. Results the incidence of deep venous thrombosis in ankylosing spondylitis group was lower than that in femoral head necrosis group. The patients with ankylosing spondylitis were younger (P 0.0001) and lower body mass index (BMI) (P 0.0036). In patients with ankylosing spondylitis, the prevalence of hypertension was 0.0001 and the prevalence of diabetes was lower. The values of PTT and INR were higher in the coagulation function group than in the femoral head necrosis group (P 0.0001). The amount of blood loss and blood transfusion in ankylosing spondylitis group was higher than that in femoral head necrosis group (P 0.0001). Conclusion 1. The incidence of venous thromboembolism in patients with ankylosing spondylitis was lower than that in patients with osteonecrosis of the femoral head. The amount of blood loss and blood transfusion increased in patients with ankylosing spondylitis using the same anticoagulant regimen after arthroplasty as those with necrosis of femoral head. In the second part, we selected a retrospective study of patients with ankylosing spondylitis who underwent total hip replacement in our hospital from January 2009 to January 2011 and January 2013 to January 2015. Patients were divided into conventional anticoagulant group, individualized weak anticoagulant group and individualized non-anticoagulant group. The baseline demographic data, the incidence of venous thromboembolism (VTE), intraoperative blood loss and blood transfusion were analyzed and compared among the three groups. Results there was no significant difference in the incidence of venous thromboembolism among the three groups. The volume of blood transfusion in individualized anticoagulant group was lower than that in routine anticoagulant group (P 0.0001). There was no significant difference in blood loss between weak anticoagulant group and non-anticoagulant group. Conclusion the amount of blood transfusion in patients with ankylosing spondylitis after hip arthroplasty with individualized anticoagulant regimen was lower than that in the routine group, and the incidence of venous thromboembolism was not statistically significant.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.4

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