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Comparison of the Risk of Perioperative Blood Loss in Hemophilic Arthritis and Initial Total Hip Arthroplasty for Femoral Head Necrosis under Multimodal Blood Management Measures: A Retrospective Cohort Study
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摘要:
目的 以股骨头坏死(osteonecrosis of the femoral head, ONFH)患者为参照, 探究在多模式血液管理措施下, 行单侧全髋关节置换术(total hip arthroplasty, THA)的血友病关节炎(hemophilia arthritis, HA)患者围术期失血及异体输血风险。 方法 回顾性收集2010年1月至2022年6月于北京协和医院接受单侧THA治疗的HA患者及按性别进行1:3匹配的ONFH患者临床资料, 比较两组围术期失血相关指标及并发症发生率差异。 结果 共入选符合纳入与排除标准的HA患者26例, ONFH患者76例。相较于ONFH患者, HA患者总失血量[(1927.08±956.59) mL比(1475.88±924.43) mL, P=0.036]、大出血率(38.46%比14.47%, P=0.009)、异体输血率(15.38%比3.95%, P=0.046)、并发症发生率(34.62%比7.89%, P=0.000)均更高, 术后第3天血红蛋白[(112.94±12.26) g/L比(117.40±11.17) g/L, P=0.000]、红细胞压积[(29.44±7.96)%比(32.80±5.52)%, P=0.019]水平均更低。 结论 在多模式血液管理措施下, 行单侧THA治疗的HA患者围术期失血及异体输血风险仍较高, 需进一步优化血液管理策略。 Abstract:Objective To compare the perioperative blood loss and risk of allogeneic transfusion between hemophilia arthritis (HA) patients and osteonecrosis of the femoral head (ONFH) patients undergoing unilateral total hip arthroplasty (THA) under multimodal blood management measures. Methods Clinical data of HA patients treated with unilateral THA from January 2010 to June 2022 and ONFH patients matched 1:3 by gender were retrospectively collected at Peking Union Medical College Hospital, and the differences in indicators related to perioperative blood loss and complication rates were compared between the two groups. Results A total of 26 patients with HA and 76 patients with ONFH who met the inclusion and exclusion criteria were enrolled.Compared with ONFH patients, the total blood loss[(1927.08±956.59) mL vs.(1475.88±924.43) mL, P=0.036], major bleeding rate (38.46%vs. 14.47%, P=0.009), allogeneic transfusion rate (15.38%vs. 3.95%, P=0.046), and complication rate (34.62%vs. 7.89%, P=0.000) in HA patients were higher, and postoperative day 3 hemoglobin[(112.94±12.26) g/L vs.(117.40±11.17) g/L, P=0.000]and hematocrit[(29.44±7.96)%vs.(32.80±5.52)%, P=0.019]were lower. Conclusion The risk of perioperative blood loss and allogeneic transfusion is higher in HA patients treated with unilateral THA than in ONFH-THA patients, and further optimization of blood management strategies is needed. 作者贡献：彭慧明负责研究设计，数据统计分析及论文撰写；陈波负责研究设计，数据收集及整理；徐溢明负责数据统计分析；冯宾、刘冠墨、王雪晴参与数据收集；翁习生负责研究设计及论文修订；所有作者均对论文进行了审阅。利益冲突：所有作者均声明不存在利益冲突 -
表 1 HA-THA组与ONFH-THA组一般资料比较
指标 HA-THA组
(n=26)ONFH-THA组
(n=76)P值 年龄(x±s, 岁) 30.46±6.78 34.41±7.40 0.018 BMI(x±s, kg/m2) 23.90±4.53 24.61±4.11 0.488 手术部位[n(%)] 0.655 左侧 11(42.3) 36(47.4) 右侧 15(57.7) 40(52.6) 术前APTT(x±s, s) 45.79±12.26 28.81±3.76 0.000 手术时间[M(P25, P75), min] 98(90, 144) 72(62, 89) 0.015 住院时间[M(P25, P75), d] 20(18, 24) 12(9, 14) 0.000 HA：血友病关节炎：ONFH：股骨头坏死；THA：全髋关节置换术；BMI：体质量指数；APTT：活化部分凝血活酶时间 
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表 2 HA-THA组与ONFH-THA主要结局指标比较
指标 HA-THA组
(n=26)ONFH-THA组
(n=76)P值 Hb 术前(x±s, g/L) 148.73±14.29 148.45±12.74 0.925 术后第1天(x±s, g/L) 124.59±11.47 123.96±12.23 0.817 术后第3天(x±s, g/L) 112.94±12.26 117.40±11.17 0.000 术后下降量* [M(P25, P75), g/L] 17(12, 27) 14(10, 18) 0.017 Hct 术前(x±s, %) 42.42±5.50 43.70±3.21 0.154 术后第1天(x±s, %) 32.06±2.90 37.01±3.39 0.950 术后第3天(x±s, %) 29.44±7.96 32.80±5.52 0.019 术后下降量*(x±s, %) 7.67±3.14 4.52±2.22 0.001 总失血量(x±s, mL) 1927.08±956.59 1475.88±924.43 0.036 隐性失血量(x±s, mL) 1526.69±835.82 1147.93±930.10 0.069 异体输血[n(%)] 4(15.38) 3(3.95) 0.046 大出血[n(%)] 10(38.46) 11(14.47) 0.009 *术前与术后5 d内最低值的差值；HA、ONFH、THA：同表 1；Hb：血红蛋白；Hct：红细胞压积
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