关键词: 凝血功能, 高凝状态, 全膝关节表面置换术, 糖尿病, 纤维蛋白原

Abstract: ［Abstract］ Objective To investigate the changes of blood coagulation status in patients with osteoarthritis of knee joint with diabetes after primary TKA. Methods A total of 60 patients with osteoarthritis were included in the research object in December 2014 to December 2016 from our hospital and underwent primary TKA surgery. According to fasting blood glucose level and history, patients were divided into two groups：diabetic group （30 cases） and normal group （30 cases）. The patients in diabetes group had average 69.70 ± 4.69 years old, 5 males and 25 females. In the normal group, the average age was 72.70±5.36 years, 4 males and 26 females. The two groups were given the same clinical intervention and treatment during the perioperative period. The blood specimens of the anterior elbow vein were collected on the fasting morning in the first, the third, and seventh days to detect the changes of prothrombin time （PT）, activated partial thromboplastin time （PTT）, thrombin time （TT）, fibrinogen （FIB）, and blood platelet （PLT）. Results The postoperative Fib change trend in two groups were are risen in the postoperative 1st day, 3rd day to the peak（diabetes group=5.25±0.82 g/L, normal group=4.44 ± 0.43 g/L）. While the Fib level in the postoperative day 7 were was less than postoperative 3rd day, but still more than preoperative level（P<0.05）. Blood Fib in diabetes group was high than the normal group in all time points（all P values <0.05）. The change trend of blood PLT counts in both groups was basically the same, and. The PLT level on the first postoperative day was significantly lower than before surgery, and dropped to the lowest value on the third postoperative day. At the seventh postoperative day, the PLT count of both groups was restored to the preoperative level. And there were no statistical differences at each time point of PLT count （all P values <0.05）. In both group, PLT, PT and APTT did not change significantly preoperative and postoperatively. Conclusion After primary unilateral TKA, hypercoagulability of blood in patients with knee osteoarthritis and diabetes is more severe than that in patients with normal fasting blood glucose. Fib is a sensitive index for detecting hypercoagulable state. Postoperative monitoring of changes in Fib index is helpful for evaluating the coagulation state of patients with knee osteoarthritis after TKA.

Key words: total knee arthroplasty, diabetes, coagulation function, hypercoagulability, fibrinogen