| Background Total knee arthroplasty(TKA)is currently recognized as an effective method for the treatment of moderate to severe knee joint degeneration.For those whose knee joint degeneration seriously affects mobility and whose conservative treatment is ineffective,TKA can significantly improve knee dysfunction and improve the quality of life.At present,TKA surgery is relatively mature,but as a major orthopedic surgery,the body’s blood is mostly in a hypercoagulable state after surgery,and it takes a long time to rest in bed.Therefore,venous thromboembolism(VTE)is a common postoperative complication.In view of the serious harm of venous thrombosis of the lower extremities,it is very important to detect the coagulation status of the body after TKA.Through the assessment of the coagulation status,the orthopedic physician can give corresponding treatment measures in time.At present,the conventional coagulation indicators for clinical detection of coagulation status include thrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),thrombin time(TT),platelet count(PLT),D-Dimers(DD),etc.These are also called traditional coagulation tests(CCT).The thromboelastogram(TEG)is a technique used to detect coagulation function that has been gradually promoted clinically in recent years,including coagulation response time(R),coagulation time(K),coagulation angle(α),and maximum thrombus strength(MA)and integrated coagulation index(CI).Objective To explore the predictive value of perioperative application of TEG and conventional coagulation indicators to detect coagulation status in lower extremity venous thrombosis.By analyzing the changes in coagulation status at different time points in the TKA perioperative period,evaluating the effectiveness and correlation of the two detection methods,screening coagulation indicators with higher diagnostic value for predicting thrombosis,providing a basis for the formulation of postoperative medication regimens,To reduce the chance of venous thrombosis of the lower limbs after TKA.Methods In this study,45 patients who had a physical examination in the Second Affiliated Hospital of Zhengzhou University from February 2019 to December 2020 were selected as the control group;75 patients underwent unilateral TKA surgery as the observation group,using low-molecular-weight heparin calcium(LMWHC)Anticoagulation.The control group only underwent TEG and CCT examinations,and the observation group underwent TEG and CCT examinations before the operation,1d,7d after the operation,and the last anticoagulation.The age,gender,weight,TEG and CCT indicators of the two groups of patients were collected.Compare the general data and basic conditions of coagulation indexes before operation between the control group and the observation group.The changes of TEG and CCT indexes at different time points before the operation,1d,7d after the operation,and the last anticoagulation in the observation group were compared.The coagulation status changes of TEG and CCT indicators in the observation group at 1 day after operation were collected and analyzed for correlation.During the last anticoagulation,the observation group underwent double lower extremity venous color Doppler ultrasound.According to the status of lower extremity venous thrombosis,it was divided into thrombotic group and nonthrombotic group.The difference indexes of the hemorrhage thrombus group were screened,and the receiver operating characteristic curve(ROC curve)was used to evaluate related difference indexes Clinical diagnostic efficacy.Results(1)There was no statistically significant difference between the control group and the observation group in age,gender,weight,TEG and CCT indicators(P>0.05).The TEG and CCT indexes of the observation group at different time points during the TKA perioperative period were statistically significant(P<0.05).(2)There were varying degrees of correlation between TEG and CCT indexes in the observation group at 1 day after operation.R and PT(r=0.616,P<0.05),R and APTT(r=0.670,P<0.05),MA and PLT(r=0.639,P<0.05),CI and Fib(r=0.647,P<0.05)Is a positive strong correlation.α and PLT(r=0.552,P<0.05),CI and PLT(r=0.599,P<0.05)are positive and moderately correlated.R and Fib(r=-0.698,P<0.05)have a strong negative correlation.K and Fib(r=-0.504,P<0.05),K and PLT(r=-0.593,P<0.05),CI and PT(r=-0.579,P<0.05),CI and APPT(r=-0.569,P<0.05)is a negative medium correlation.(3)In the last anticoagulation,ultrasound showed 13 cases of venous thrombosis of the lower extremities.The K,α,MA,CI,PT,APTT,D-D and other indicators of the thrombosis group were statistically different from those of the non-thrombosis group(P<0.05).The ROC curve results show that the area under the α,MA,CI,DD index curve is 0.739,0.692,0.850,0.916,the sensitivity is 69.23%,92.31%,69.23%,92.31%,and the specificity is 79.03%,46.77%,91.94%,82.26%,the best diagnosis point is 67.5°,64.6mm,1.645,2.03 ug/ml.Therefore,α,MA,CI,D-D indicators have the highest diagnostic value for lower extremity venous thrombosis.Conclusions(1)Both TEG and CCT are effective indicators for detecting the coagulation status of the body,and both can accurately respond to the blood hypercoagulability after TKA.(2)Some indicators of TEG and CCT have a certain correlation,but the detection principles of the two are different.CCT indicators cannot reflect functional coagulopathy,and the consistency between the two is poor.(3)TEG can dynamically detect changes in coagulation status,and TEG has higher sensitivity and accuracy than CCT.Among them,α,MA,CI,D-D indicators have the highest diagnostic value in predicting venous thrombosis of the lower extremities.Anticoagulant measures should be taken in time for patients whose blood coagulation reaches the above indicators after TKA.(4)The blood is in a hypercoagulable state after TKA,and anticoagulation therapy should be routinely performed.The application of TEG to detect the coagulation state can predict venous thrombosis. |
PDF Full Text Request