背景:创伤诱导的凝血病在多发伤背景下已被广泛研究,但只是在中度骨科创伤后稀疏。这项研究的目的是评估髋部骨折患者的止血剖面的变化,使用旋转血栓弹性测定法(ROTEM)。
方法:198例接受手术治疗的髋部骨折患者被纳入研究。还招募了52名健康个体的匹配组。人口统计,常规实验室化验,记录并比较患者和健康成人之间的ROTEM参数。还比较了骨折患者术前和术后的ROTEM值。
结果:两组的常规凝血试验相似。然而,几个ROTEM参数,包括EXTEMMCF(P<.001),EXTEMα角(P<.001),INTEMMCF(P<.001),INTEMA10(P<.001),两组间INTEMα角(P<.001)显著不同,表明髋部骨折后凝血电位较高。此外,骨折患者的INTEM和EXTEMCT值显著较低(分别为P=.008和P=.012),INTEM和EXTEMCFT值显著较低(P<.001).对混杂因素的调整分析进一步证实了髋部骨折与较高的凝血活性之间的直接关系。最后,INTEMCT和CFT显着降低(分别为P=.008和P<.001),而INTEMMCF,术后A10和α角显着增加(P<0.001),表明手术进一步增加了凝血潜能。
结论:损伤后不久,ROTEM可以检测到髋部骨折和手术治疗后更高的凝血活性,即使这是无法通过常规凝血检测。
BACKGROUND: Trauma-induced coagulopathy has been extensively investigated in the multitrauma setting, but only sparsely following moderate orthopedic trauma. The purpose of this study was to evaluate changes in the hemostatic profile of patients with hip fractures, using rotational thromboelastometry (ROTEM).
METHODS: 198 patients with hip fractures who underwent surgery were included in the study. A matched group of 52 healthy individuals was also enrolled. Demographics, conventional laboratory assays, and ROTEM parameters were recorded and compared between patients and healthy adults. The preoperative and postoperative ROTEM values of fractured patients were also compared.
RESULTS: The conventional coagulation assays were similar for the 2 groups. However, several ROTEM parameters including EXTEM MCF (P < .001), EXTEM alpha angle (P < .001), INTEM MCF (P < .001), INTEM A10 (P < .001), and INTEM alpha angle (P < .001) significantly differed between the 2 groups indicating a higher coagulation potential following hip fractures. Also, fractured patients had significantly lower INTEM and EXTEM CT values (P = .008 and P = .012, respectively) and significantly lower INTEM and EXTEM CFT values (P < .001). Adjusted analysis for confounders further confirmed the direct relationship between hip fracture and higher coagulation activity. Last, INTEM CT and CFT significantly decreased (P = .008 and P < .001, respectively), while INTEM MCF, A10, and alpha angle significantly increased (P < .001) postoperatively, indicating that surgery further increases the coagulation potential.
CONCLUSIONS: A higher coagulation activity following hip fractures and surgical treatment can be detected by ROTEM shortly after the injury, even when this is undetectable by conventional coagulation assays.