Reikeras Olav, Clementsen Torkil
Department of Orthopaedics, Rikshospitalet University Clinic, University of Oslo, Norway.
J Orthop Surg (Hong Kong). 2009 Dec;17(3):291-5. doi: 10.1177/230949900901700309.
To compare the thrombosis markers for thrombosis and fibrinolysis in patients undergoing hip versus knee arthroplasty.
Seven women aged 38 to 61 years who underwent total hip arthroplasty (THA) and 7 women aged 57 to 67 years who underwent total knee arthroplasty (TKA) were studied. Thromboprophylaxis was given before and after surgery. In patients undergoing TKA, an automatic pneumatic tourniquet was used. Blood samples were drawn (1) before surgery (control value), (2) at wound closure (immediately before release of the tourniquet in TKA), and (3) 4 hours after surgery. Thrombosis markers (prothrombin fragment 1.2 [F1.2], plasmin/ alpha2-antiplasmin complex [PAP], and D-dimer) of the 2 groups were compared.
The F1.2 level increased significantly at wound closure and remained elevated 4 hours after surgery in the THA group, whereas it was unchanged at wound closure but increased significantly 4 hours after surgery in the TKA group. The PAP level was constant peri- and post-operatively in the THA group, whereas it increased significantly 4 hours after surgery in the TKA group. The D-dimer level increased significantly at wound closure and 4 hours after surgery in the THA group, whereas it was unchanged at wound closure but increased significantly 4 hours after surgery in the TKA group.
Systemic thrombin generation starts perioperatively in THA and after tourniquet deflation in TKA, indicating that wound blood must reach the systemic circulation to activate the relevant mediators.
比较髋关节置换术与膝关节置换术患者的血栓形成和纤维蛋白溶解相关血栓标志物。
研究了7名年龄在38至61岁接受全髋关节置换术（THA）的女性和7名年龄在57至67岁接受全膝关节置换术（TKA）的女性。手术前后均进行了血栓预防。在接受TKA的患者中，使用了自动充气止血带。在（1）手术前（对照值）、（2）伤口缝合时（TKA中止血带松开前即刻）和（3）手术后4小时采集血样。比较两组的血栓标志物（凝血酶原片段1.2 [F1.2]、纤溶酶/α2-抗纤溶酶复合物[PAP]和D-二聚体）。
THA组F1.2水平在伤口缝合时显著升高，并在术后4小时仍保持升高，而TKA组在伤口缝合时未改变，但在术后4小时显著升高。THA组PAP水平在围手术期和术后保持恒定，而TKA组在术后4小时显著升高。THA组D-二聚体水平在伤口缝合时和术后4小时显著升高，而TKA组在伤口缝合时未改变，但在术后4小时显著升高。
THA手术期间及TKA止血带放气后开始出现全身凝血酶生成，表明伤口血液必须进入体循环才能激活相关介质。
