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 对比在多模式血液管理措施下,血友病关节炎(hemophilia arthritisHA)与股骨头坏死(osteonecrosis of the femoral head,ONFH)行单侧全髋关节置换(Total hip arthroplasty THA)围手术期失血量及异体输血风险。 方法 回顾性纳入2010年1月1日至2022年6月15日接受单侧THA并符合标准的26例HA患者,平均年龄(30.46±6.78)岁,BMI(23.90±4.53) kg/m2;按照1:3匹配76例接受单侧THA的ONFH患者。两组均为男性,平均年龄(34.41±7.398)岁,BMI(24.61±4.11) kg/m2;比较两组人口学资料,中位手术时间、中位住院时间,术前及术后第1、3天血红蛋白及红细胞压积、术后血红蛋白及红细胞压积下降值、总失血量、输血比例及并发症情况。 结果: HA-THA组术后总失血量[(1927.08±956.60) mL比(1475.88±924.43) mL,P=0.036]及隐性失血量[(1526.70±835.82) mL比(1147.94±930.10) mL,P=0.069]均多于对照;大出血率高于对照组(38.46%比15.38%,P=0.002);输血率高于对照组(15.38%比9.89%,P=0,012);中位手术时间长于对照组(98min比77min,P=0.015);中位住院时间明显长于对照组(20天比12天,P=0.000)。 结论 单侧HA-THA的围手术期失血及异体输血风险相比ONFH-THA患者仍高,需进一步研究预防性和有效的方法来降低HA-THA失血风险。
Abstract:Objective We aim to compare the perioperative blood loss and risk of allogeneic transfusion between hemophilia arthritis (HA)patients and osteonecrosis of the femoral head (ONFH) patients underwent unilateral total hip arthroplasty ( THA) under multimodal blood management measures. Methods: 26 patients with HA who underwent unilateral THA from January 1, 2010, to June 15, 2022, and met the criteria, with a mean age of (30.46±6.78) years and BMI of (23.90±4.53) kg/m2, were retrospectively included; 76 patients with ONFH who underwent unilateral THA were matched according to 1:3. All were male, mean age (34.41±7.398) years, BMI (24.61±4.11) kg/m2; demographic data, median operative time, median hospital stay, preoperative and postoperative day 1 and 3 hemoglobin and hematocrit, postoperative hemoglobin and hematocrit decline values, total blood loss, transfusion ratio, and complications were compared between the two groups. Results: There was significantly more total blood loss ((1927.08±956.60) mL vs. (1475.88±924.43) mL, P=0.036) and hidden blood loss (1526.70±835.82 mL vs. (1147.94±930.10) mL, P=0.069), higher rate of major bleeding (38.46% vs. 15.38%, P=0.002); higher transfusion risk (15.38% vs. 9.89%, P=0.012); longer median operative time (98min vs. 77min, P=0.015); and longer median hospital stay (20 days vs. 12 days, P=0.000) in HA-THA group than in ONFH-THA group. Conclusion: The risk of perioperative blood loss and allogeneic transfusion is still high in unilateral HA-THA compared to ONFH-THA patients. Further research is needed on prophylactic and effective methods to reduce the risk of blood loss in HA-THA.
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Key words:
- hip replacement /
- arthroplasty /
- hemophilia /
- factor replacement /
- blood loss
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