中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (22): 4023-4027.doi: 10.3969/j.issn.1673-8225.2011.22.009

• 人工假体 artificial prosthesis • 上一篇    下一篇

血友病患者全膝置换围手术期的凝血因子替代治疗

张  卓，关振鹏，孙铁铮，李云鹏，裴  征，张绍龙，吕厚山   

  1. 北京大学人民医院关节病诊疗研究中心，北京市  100044
  • 收稿日期:2010-12-31 修回日期:2011-03-18 出版日期:2011-05-28 发布日期:2011-05-28
  • 通讯作者: 关振鹏，博士，主任医师，副教授，硕士生导师，北京大学人民医院关节病诊疗研究中心，北京市 100044 guan_zhenpeng@sina.com
  • 作者简介:张卓☆，男，1984年生，北京市人，汉族，2010年北京大学医学部毕业，博士，主要从事骨科相关疾病的诊治。 zhangzhuo_zz@yahoo.com.cn

Coagulation factor replacement in total knee arthroplasty for hemophilic patients

Zhang Zhuo, Guan Zhen-peng, Sun Tie-zheng, Li Yun-peng, Pei Zheng, Zhang Shao-long, Lü Hou-shan   

  1. Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing  100044, China
  • Received:2010-12-31 Revised:2011-03-18 Online:2011-05-28 Published:2011-05-28
  • Contact: Guan Zhen-peng, Doctor, Chief physician, Associate professor, Master’s supervisor, Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing 100044, China guan_zhenpeng@sina.com
  • About author:Zhang Zhuo☆, Doctor, Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing 100044, China zhangzhuo_zz@yahoo.com.cn

PDF

479

被引次数

13

摘要：

背景：世界血友病协会的治疗指南明确表示，关节置换应当在保证患者凝血因子活性的情况下进行。
目的：观察血友病关节炎患者行人工膝关节置换围手术期凝血因子替代治疗的安全性和有效性。
方法：1997/2006在血液内科的配合下，围手术期行凝血因子Ⅷ和Ⅸ活性水平监测，根据指南制定常规流程，进行因子Ⅷ(冻干人凝血因子Ⅷ)或因子Ⅸ(凝血酶原复合物)的替代治疗，对4例血友病关节炎患者共6个膝关节行人工膝关节置换治疗。
结果与结论：围手术期应用凝血因子进行常规替代治疗，血友病患者围手术期出血量与类风湿关节炎和骨关节炎患者差异无显著性意义(P=0.885)。置换后早期3个膝关节出现关节内血肿或肌肉出血，其中1例患者因凝血因子抑制性抗体形成，导致1侧膝关节置换后伤口裂开，行扩创清理后，伤口愈合良好。4例患者6个膝关节置换后没有晚期感染、假体松动、移位和断裂等并发症发生。所有4例患者置换前膝关节KSS评分平均28.2分，功能评分平均35分。置换后KSS评分85.2分，功能评分87分，与普通类风湿关节炎和骨关节炎膝关节置换后评分相似，但平均住院天数延长约3倍，住院费用为普通膝关节置换的2.5~3倍。结果显示凝血因子的替代治疗和凝血因子水平监测是保证血友病关节炎行人工膝关节置换最后成功的关键。

关键词: 血友病关节炎, 膝关节置换, 凝血因子, 替代治疗, 围手术期

Abstract:

BACKGROUND: According to the guidelines of World Hemophilia Association, joint replacement should ensure the activity of coagulation factors in patients.
OBJECTIVE: To summarize the safety and validity of coagulation factor replacement in hemophilic arthritis patients undergoing total knee arthroplasty (TKA).
METHODS: Between 1997 and 2006, we performed TKA on 4 hemophilic arthritis patients with 6 knee joints. Under the cooperation with the Hematology Department, we monitored levels of factors Ⅷ and Ⅸ perioperatively, and established routine process of factor replacement, according to the guideline of World Hemophilia Association, and factor replacement had been performed.
RESULTS AND CONCLUSION: Hemophilic patients who had undergone therapy of perioperative coagulation factor replacement could suffer treatment of TKA. There was no significant difference in the amount of bleeding between patients with hemophilia and those with either of rheumatoid arthritis or osteoarthritis (P=0.885). Intraarticular bleeding occurred in 3 knees of 2 patients, and another with formation of inhibitor, which led to incision split in 1 knee. The wound healed well after treatment of epluchage. No other early or further complications had occurred. The average preoperative KSS score was 28.2 points, and the average functional score was 35 points, as compared to the postoperative average scores of 85.2 points by KSS and 87 for function. Recovery of the hemophilic arthritic knee was similar to the result of a regular TKA, while there were increases of three times in the hospitalized days and 2.5-3 times to the cost of a regular replacement surgery. Coagulation factor replacement and monitoring of coagulation factor levels are the key to the success of TKA in hemophilic arthritis patients.

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