合并血友病的全膝关节置换术围术期研究进展

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摘要血友病为一组遗传性凝血功能障碍的出血性疾病，在男性中更为常见。其由于缺乏凝血因子Ⅷ(FⅧ)或凝血因子Ⅸ(FⅨ)，活性凝血活酶生成障碍，凝血时间延长，具有轻微创伤后出血倾向，重症患者即使没有明显外伤也可发生“自发性”出血。血友病根据血浆因子水平6％~40％、1％~5％或小于1％分为轻度、中度或重度。在FⅧ或FⅨ只有正常活性1％的重度血友病患者中，每年可能会频繁发生20~30次关节出血事件。
终生因子替代疗法对于延长血友病患者预期寿命并减少肌肉骨骼出血至关重要。但是，由于治疗因子剂量不足，药物依从性差或对因子产生靶向因子Ⅷ或Ⅸ的抗体(抑制剂作用)，肌肉骨骼出血等并发症仍可能发生。血友病患者关节出血的最常见部位是踝、肘和膝关节，关节内反复出血引起的炎症反应会导致急慢性疼痛、软骨损伤、关节退变和功能丧失，并最终演变成严重的骨关节炎。目前已经发现有90％的血友病患者在发病30年后会发展为血友病性关节炎。对于血友病性慢性滑膜炎，化学和放射性核素滑膜切除术可以延缓发展为血友病性关节炎；对于严重的血友病性关节炎则应考虑手术治疗。全膝关节置换术(total knee arthroplasty，TKA)是晚期血友病性膝关节病患者缓解疼痛和改善功能的有效方法。本文对血友病患者TKA围术期管理、术中注意事项、假体选择、术后康复及相关并发症的最新文献进行综述。

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	余鹏 1
	孙长鲛 2*
	蔡谞 2

通讯作者: 孙长鲛

作者简介: 余鹏(1976－ )，男，主治医师，武汉科技大学医院骨科，430031。

引用本文:

余鹏 1，孙长鲛 2*，蔡谞 2. 合并血友病的全膝关节置换术围术期研究进展[J]. 实用骨科杂志, 2021, 27(12): 1117-1121.

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