摘要
目的通过随机对照研究，探讨全髋关节置换术后深静脉血栓形成的发生率和预防措施。方法2007年5月至2008年12月行全髋关节置换术的141例患者，男53例，女88例；年龄17-86岁，平均（63．20213．78）岁。根据是否使用低分子肝素随机分成抗凝组（82例）和非抗凝组（59例），术后均行患肢深静脉顺行性造影，明确血栓发生的部位、大小及数量。诊断标准根据1972年Rabinov和Paulin提出的诊断标准，结合国内吕厚山的相关经验进行统一诊断。根据下肢血栓的部位将血栓分为中央型、周围型和混合性血栓。结果全髋关节置换术后深静脉血栓形成的发生率为32．62％（46例），其中中央型1例，混合型2例，周围型43例。临床症状有小腿后侧疼痛，沉重或紧张，足和踝关节周围轻度肿胀。临床体征有肌肉压痛、Homans征或Neuhof征阳性。将症状和体征都作为临床依据，其中无临床依据者共34例，占73．9％。抗凝组（82例）和非抗凝组（59例）深静脉血栓形成发生率的差异无统计学意义。结论采用数字化下肢深静脉造影技术能准确地发现全髋关节置换术后深静脉血栓形成，临床症状与其无直接关联，低分子肝素抗凝后虽能降低深静脉血栓形成的发生率，但差异无统计学意义。
Objective To investigate the incidence rate and prevention of deep vein thrombosis （DVT） after total hip arthroplasty （THA）. Methods From May 2007 to Deeember 2008, 141 patients with THA underwent deep vein anterograde venography of lower limb in order to find the location, size and number of thrombus. There were 53 males and 88 females in our study. The patients ranged from 17 to 86 years old, with an average age of （63.20±13.78） years. The patients were randomly divided into antieoagulation group and non-antieoagulation group aeeording to the use of low-molecular-weight heparin （LMWH） or not. There were 82 patients in non-antieoagulation group and 59 ptients in non-antieoagulation group. The diagnosis of DVT was according to the criterion recommended by Rabinov and Paulin in 1972, eombining with the experience of the civil scholars. Depending on the finding of deep vein anterograde venography, the DVT was elassified into proximal type, distal and mixed ones. Results The incidenee rate of DVT after THA was 32.62% （46 patients）. There were proximal DVT in one ease, mixed DVT in two eases, distal DVT in 43 eases. Thirty-four patients （73.9%） had not obvious elinieal signs and symptoms. There was no difference in ineidenee rate between the non-anticoagulation group （59 patients） and anticoagulation group （82 patients）. Conclusion The ineident of DVT after THA can be found accurately by digital lower limb venography technology. There is no direct relation between clinical DVT and elinieal evidence. LHMN can decrease the incident rate, but there is no statistical significance. It is necessary to adopt individual thromboembolism prophylaxis measures.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2010年第4期381-385,共5页
Chinese Journal of Orthopaedics
基金
国家自然科学基金面上项目（30973046）
关键词
关节成形术
置换
髋
静脉血栓
随机对照试验
Arthroplasty, replacement, Hip
Venous thrombosis
Randomized controlled trials
