| Objectives:On the one hand,compare the effects of rivaroxaban anticoagulation treatment after UKA and TKA,evaluate the difference in the effects of the two early post-operations at different times,and explore the time limit of anticoagulation treatment suitable for UKA;On the other hand,a comparative observation of the anticoagulation effect and safety of rivaroxaban and aspirin at different times after the early anticoagulation treatment after UKA operation confirmed whether there is a significant difference in the anticoagulation time after the use of two different drugs.Methods:A total of 50 inpatients who were admitted to the Department of Joint Surgery of Sichuan Provincial People’s Hospital from April 2020 to February 2021 and planned to undergo UKA and TKA surgery were selected,of which 30 patients were planned to undergo UKA surgery.The included patients were divided into experimental group A and control group B by random number table method,with 15 patients in each group.Twenty TKA patients with the same age and similar disease course were selected as group C for analysis.1.Experiment 1: Experimental group A(15 cases)underwent unicompartmental knee arthroplasty,and oral anticoagulation therapy with rivaroxaban after the operation;control group C(20 cases)underwent total knee replacement surgery and oral anticoagulant therapy with rivaroxaban after the operation.2.Experiment 2: Experimental group A(15 patients)underwent unicompartmental knee arthroplasty,and rivaroxaban was used as anticoagulant after surgery,10 mg po qd;control group B(15 cases)underwent unicompartmental knee arthroplasty,after which aspirin was used as anticoagulant,100 mg po qd.Preoperatively complete the thromboelastogram,full set of coagulation function,blood routine and color Doppler ultrasound examination of both lower extremities to understand the status of thrombus and coagulation function.After the operation,anticoagulation treatment was given according to the anticoagulation treatment plan of total knee arthroplasty in the 2016 edition of the "Guidelines for the Prevention of Venous Thromboembolism in Major Orthopaedic Surgery in China".Fasting venous blood samples were respectively collected on the preoperative day and postoperative 1d,4d,7d for TEG,D-dimer,fibrinolytic protein degradation products(FDP),coagulation function,blood routine indicators;Color Doppler ultrasonography of deep veins of both lower limbs was performed before and 7 day after operation;The circumference at 10 cm of the superior patellar edge of the knee on the operative side was measured before and 1 day after the operation;The anesthesia time,tourniquet time and operation time of the two groups were counted.SPSS 22.0 software was used for statistical analysis of the obtained data,and P <0.05 was statistically significant.Result:Experiment 1:1.There was no statistically significant difference between the UKA and TKA groups in the circumference of the upper edge of patella 10 cm before and after surgery(P >0.05).Compared within the group,the postoperative circumference of the two groups of patients was increased compared with that before the operation,and the difference was statistically significant(P<0.05).2.The anesthesia time and tourniquet pressure of the two groups of patients were not statistically significant(P>0.05);the UKA operation time and tourniquet use time were significantly shorter than those of TKA surgery(P<0.05).3.Comparison of postoperative blood loss between the two groups,the total blood loss in the UKA group was significantly lower than that in the TKA group(P<0.05),but there was no significant difference in the amount of hidden blood loss between the two groups(P>0.05).4.Comparison of laboratory indicators between the two groups on the first day after surgery:Comparison between the two groups,there was no statistically significant difference in Hb and PLT values in blood routine indicators between the groups(P>0.05);There was no significant difference in coagulation function PT,APTT,TT,INR indicators(P>0.05);There was no significant difference in D-dimer and FDP(P>0.05);There was no statistically significant difference in the CI,K,R,a,and MA of the thromboelastogram(P>0.05).Comparison within group: Hb,D-dimer and FDP values were significantly different from those before operation(P < 0.05).Therefore,both groups of patients had hypercoagulability on the first day after surgery.5.Comparison of laboratory indicators between the two groups on day 3 after surgery the third day after surgery:Comparison between the two groups,the Hb value of UKA group was higher than that of TKA group,and the difference was statistically significant(P < 0.05);PLT indexes were higher than those before operation,but the difference was not statistically significant(P>0.05).There was no significant difference in FDP,PT,APTT,TT and INR of coagulation function(P>0.05).The difference of D-dimer index was statistically significant(P < 0.05),which confirmed that the hypercoagulant state had recovered in the UKA group 3 days after surgery.There was no statistically significant difference in the CI,a and MA of the thromboelastogram(P>0.05),however,there were statistically significant differences in K and R indexes of thromboelastic graph(P < 0.05).Comparison within group:The Hb and MA values were significantly different from those before operation(P < 0.05).There were statistically significant differences in CI,K and MA values in TKA group(P < 0.05).However,there was no statistical significance in other indicators in UKA group(P > 0.05).In summary,on the third day after surgery,the blood of the two groups still had hypercoagulable state,but it has gradually recovered.6.Comparison between the two groups on the 7th day after surgery:Comparison between the two groups,there were no significant differences in Hb and PLT(P>0.05).There was no significant difference in PT,APTT,TT and INR of coagulation function(P>0.05).here was no significant difference in D-dimer and FDP(P>0.05).There was no statistically significant difference in the CI,K,R,a,and MA of the thromboelastogram(P>0.05).Comparison within group:There is no significant difference in Hb,PLT,PT,APPT,TT,INR and thromboelastogram indicators(P>0.05).In the UKA group,there was no statistically significant difference in each index,and the hypercoagulability state was significantly improved,which was not significantly different from that before operation.However,the values of D-dimer,FDP,CI,A and MA in TKA group were significantly different from those before surgery(P < 0.05),and hypercoagulability was still present.7.No symptomatic DVT or pulmonary embolism occurred in 2 groups within 7 days after surgery,and no thrombosis was found in lower limb vein color ultrasound results.8.Bleeding complications: Ecchymosis occurred around the wound in 1 case in the TKA group,but not in the UKA group: there was no statistical significance between the two groups(P > 0.05).Experiment 2:1.There was no statistically significant difference between the UKA and TKA groups in the circumference of the upper edge of patella 10 cm before and after surgery(P >0.05).Compared within the group,the postoperative circumference of the two groups of patients was increased compared with that before the operation,and the difference was statistically significant(P<0.05).2.The anesthesia time,tourniquet pressure,operation time and tourniquet use time of the two groups of patients were not statistically significant(P>0.05).3.Comparison of postoperative blood loss between the two groups,the total blood loss and the hidden blood loss were not significantly different between the two groups(P>0.05).4.Comparison of laboratory indicators between the two groups on the first day after surgery:Comparison between the two groups,there was no statistically significant difference in Hb and PLT values in blood routine indicators between the groups(P>0.05);There was no significant difference in coagulation function PT,APTT,TT,INR indicators(P>0.05);There was no significant difference in D-dimer and FDP(P>0.05);There was no statistically significant difference in the CI,K,R,a,and MA of the thromboelastogram(P>0.05).Comparison within group: Hb,D-dimer and FDP values were significantly different from those before operation(P < 0.05).Therefore,both groups of patients had hypercoagulability on the first day after surgery.5.Comparison of laboratory indicators between the two groups on the third day after surgery:Comparison between the two groups,there was no statistically significant difference in Hb and PLT values in blood routine indicators between the groups(P>0.05);There was no significant difference in coagulation function PT,APTT,TT,INR indicators(P>0.05);There was no significant difference in D-dimer and FDP(P>0.05);There was no statistically significant difference in the CI,K,R,a,and MA of the thromboelastogram(P>0.05).Comparison within group:There is no significant difference in Hb,PLT,PT,APPT,TT,INR and thromboelastogram indicators(P>0.05);D-dimer and FDP values were significantly different from those before operation(P < 0.05).In summary,on the third day after surgery,the blood of the two groups still had hypercoagulable state,but it has gradually recovered.6.Comparison of laboratory indicators between the two groups on the 7th day after surgery:Comparison between the two groups,there were no significant differences in Hb and PLT(P>0.05).There was no significant difference in PT,APTT,TT and INR of coagulation function(P>0.05).here was no significant difference in D-dimer and FDP(P>0.05).There was no statistically significant difference in the CI,K,R,a,and MA of the thromboelastogram(P>0.05).Comparison within group:There is no significant difference in Hb,PLT,PT,APPT,TT,INR and thromboelastogram indicators(P>0.05);D-dimer and FDP values were significantly different from those before operation(P < 0.05),but it is closer to normal than on the 3rd day before surgery.In summary,on the third day after surgery,the blood of the two groups still had hypercoagulable state,but it has gradually recovered.7.No symptomatic DVT or pulmonary embolism occurred in 2 groups within 7 days after surgery,and no thrombosis was found in lower limb vein color ultrasound results.8.No bleeding complications occurred in the two groups: there was no statistically significant difference in the results between the two groups(P > 0.05).Conclusion:In summary,The risk of early deep vein thrombosis after unicondyle replacement and total knee arthroplasty is significantly increased,and active anticoagulation treatment is required.There is a significant difference in the risk of thrombosis at different time points after unicondyle replacement and total knee arthroplasty,and the risk has returned to the preoperative level 7 days after surgery.Conventional doses of rivaroxaban and aspirin have no significant difference in anticoagulation efficacy and safety at different times after unicondylar replacement,and there is no significant difference in thrombosis risk level 7days after surgery and preoperative.Therefore,the current anticoagulation time limit and anticoagulation program applicable to total knee arthroplasty are not suitable for unicondyle replacement,and should be appropriately shortened and changed. |
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