股骨髓腔内止血在全髋关节置换术中的应用*

目的探讨股骨髓腔内使用微孔多聚糖止血球止血，对于减少全髋关节置换术失血的安全性和有效性。方法选择初次单侧人工生物型假体全髋关节置换患者90侧。采用抛硬币法随机分为试验组（术中股骨髓腔内止血），对照组（不予股骨髓腔内止血）两组。两组均常规使用氨甲环酸（术前30 min，1g/100mL静脉滴注，术毕术区灌注0.5g/50mL，术后6 h，1g/100mL，静脉滴注）止血基础上，股骨髓腔内选用微孔多聚糖止血球止血。手术均采用后外侧入路(改良Gibson入路)，由同一术者完成。结果术中股骨髓腔内止血组的总出血量、术中出血量、隐性失血量、术后引流量均显著少于对照组，差异有统计学意义（P＜0.05），两组均无输血患者，均未发生感染，均有一例患者发生深静脉血栓，两组患者术后半年均无假体松动，术后半年患者髋关节功能评分（Harris评分）差异无统计学意义。结论试验表明股骨髓腔使用微孔多聚糖止血球止血，能有效、安全地减少初次单侧人工生物型假体全髋关节置换的出血。

英文摘要:

Objective Investigate the safety and efficacy of using microporous polysaccharide hemospheres（MPH）in the femoral marrow cavity during total hip arthroplasty (THA). Methods 90 patients were received unilateral uncemented total hip arthroplasty, and randomly divided into two groups: experiment group, MPH was applied in the femoral marrow cavity. Control group, MPH was not applied. Both of the groups were received tranexamic acid (TXA) conventionally. Operations were performed with modified Gibson approach by the same surgeon. Results The total blood loss, blood loss in operation, hidden blood loss and drain volume after operation are significantly lower in experiment group (P＜0.05). No patient received blood transfusion and got infection, and each of the two groups had one patient got deep venous thrombosis, two groups showed no significantly difference in harris hip score and no patient got prothesis loosening after half a year. Conclusion The results show using MPH in the femoral marrow cavity during total hip arthroplasty is efficacy and safety.

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