促红细胞生成素和铁剂在激素性股骨头坏死全髋关节置换术中的应用研究

Application of Erythropoietin and Iron in Total Hip Arthroplasty of Hormonal Osteonecrosis of Femoral Head

摘要: 目的：观察促红细胞生成素联合静脉铁剂治疗在激素性股骨头坏死患者全髋关节置换术中的有效性及安全性。方法：选取2018年9月至2020年9月在临沂市人民医院股骨头专科符合纳入和排除标准的并需初次行单侧全髋关节置换术的激素性股骨坏死患者100例，入院患者随机分为观察组和对照组两组，各50例。观察组患者在术中应用氨甲环酸(TXA)联合围术期应用EPO和静脉铁剂，对照组仅术中应用TXA。两组术前基本资料差异无统计学意义。对术前、术后血红蛋白变化、红细胞指数、红细胞压积、Harris评分等指标进行评估。结果：两组术前一般情况比较差异无统计学意义(P > 0.05)。两组术前血红蛋白、红细胞压积及Harris评分比较差异无统计学意义(P > 0.05)。治疗组术后第3、5、7天的血红蛋白、红细胞数、红细胞压积比较水平均高于对照组，差异有统计学意义(P < 0.05)；两组患者Harris评分在术后3月比较具有统计学意义(p < 0.05)。结论：促红细胞生成素联合静脉铁剂治疗可安全有效地降低激素性股骨头坏死患者行全髋关节置换术后的贫血机率，促进患者术后功能锻炼及快速康复。

Abstract: Objective: To observe the effectiveness and safety of erythropoietin combined with intravenous iron in the treatment of hormonal osteonecrosis of the femoral head in total hip arthroplasty. Methods: A total of 100 patients with hormonal osteonecrosis of the femur who met the inclusion and exclusion criteria in the Femoral Head Specialty of Linyi People's Hospital from September 2018 to September 2020 and required initial unilateral total hip replacement were selected. The admitted patients were randomly divided into observation group and control group, 50 cases in each group. Patients in the observation group received intraoperative tranexamic acid (TXA) combined with perioperative use of EPO and intravenous iron, while the control group received only intraoperative TXA. There was no statistically significant difference in basic data between the two groups before operation. Preoperative and postoperative hemoglobin changes, red blood cells, hematocrit, Harris score and other indicators were evaluated. Results: There was no statistically significant difference in general conditions between the two groups before operation (P > 0.05). There was no significant difference in hemoglobin, hematocrit and Harris score between the two groups before operation (P > 0.05). The comparative levels of hemoglobin, red blood cell count, and hematocrit of the treatment group were higher than those of the control group on the 3rd, 5th, and 7th day after operation, and the difference was statistically significant (P < 0.05); the comparison of Harris score between the two groups at 3 months after operation was statistically significant (P < 0.05). Conclusion: Erythropoietin combined with intravenous iron therapy can safely and effectively reduce the risk of anemia in patients with hormonal osteonecrosis of the femoral head after total hip replacement, and promote postoperative functional exercise and rapid recovery.