探讨骨质疏松对全膝关节置换(TKA)患者围手术期的总失血量、显性失血量及隐性失血量之间的影响。

回顾分析2017年1月至2018年12月在广西壮族自治区人民医院因膝骨关节炎(KOA)伴或不伴原发性骨质疏松症行单侧TKA的89例患者的病例资料，男性40例，女性49例，平均年龄(71±6)岁。骨质疏松组和骨量正常各35例，骨量减少组为19例。记录患者性别、年龄、身高、体重、身体质量指数(BMI)、手术时间、术中失血量以及术前术后血红蛋白(Hb)、红细胞压积(Hct)。应用公式计算出每位患者的总失血量、显性失血量、隐性失血量，采用单因素方差分析比较三组间数据差异，应用SNK-q检验两两比较组间数据差异。

所有患者的手术均由同组医师完成。三组患者的一般资料如性别、年龄、BMI、手术时间、手术前Hct、Hb水平等均差异无统计学意义(均为P>0.05)。骨质疏松组总失血量和隐性失血量均显著高于骨量正常组及骨量减少组，差异有统计学意义(F＝25.798、23.502，均为P<0.05)，显性出血量的差异无统计学意义(P>0.05)。

骨质疏松患者在行全膝关节置换术后总出血量、隐性出血量多于骨量减少及骨量正常的患者，因此应重视和治疗有膝关节骨关节炎合并骨质疏松的患者。

To explore the influence of primary osteoporosis and total knee arthroplasty (TKA) on perioperative total blood loss, dominant blood loss and invisible blood loss.

Retrospective analysis was carried out on the data of 89 patients with or whithout primary osteoporosis who underwent unilateral TKA caused by knee osteoarthritis (KOA) in the People’s Hospital of Guangxi from January 2017 to December 2018, including 40 males and 49 females, with an average age of (71±6) years. There were 35 cases in the osteoporosis group and 35 cases in the normal bone mass group, and 19 cases in the decreased bone mass group. Gender, age, height, weight, body mass index(BMI), operation time, intraoperative blood loss and preoperative and postoperative hematocrit (Hct) were recorded. The total blood loss, dominant blood loss and recessive blood loss of each patient were calculated. One way ANOVA was used to compare the data differences among the three groups, and SNK-q test was used to analyze the data differences between the two groups.

All the patients were operated by the same group of physicians. There was no statistically significant difference in basic data among the three groups, such as gender, age, BMI, operative time, preoperative Hct and hemoglobin(Hb) levels (all P>0.05). The total blood loss and hidden blood loss of the osteoporosis group were significantly higher than the normal bone mass group and the reduced bone mass group (F=25.798, 23.502, both P<0.05), while the dominant blood loss showed no statistically significant difference (P>0.05).

The patients with osteoporosis after total knee arthroplasty have more total and recessive blood loss than those with bone loss and normal bone loss, so that the patients with knee osteoarthritis combined with osteoporosis should be paid attention to and treated.