全髋关节置换术后早期主动规律锻炼预防深静脉血栓形成 81例(92髋)血栓发生率4.94%  

Active regular exercises as early as possible in the prevention of deep venous thrombosis after total hip replacement: An incidence rate of 4.94% in 81 cases (92 hip joints)

作　　者：沈慧勇[1] 杨睿[1] 唐勇[1] 程志安[1] 黄霖[1] 黄建荣[1] 林道贤[1] 

机构地区：[1]中山大学附属第二医院骨科,广东省广州市510120

出　　处：《中国临床康复》2005年第26期4-6,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:观察全髋关节置换术后早期主动规律的锻炼对预防深静脉血栓形成的有效性。方法:选择2000-02/2004-04中山大学附属第二医院骨科收治的髋关节疾病行全髋关节置换患者81例(92髋)。股骨头无菌性坏死34例,股骨颈骨折29例,骨性关节炎8例,髋关节翻修4例,陈旧性髋关节结核2例,强直性脊柱炎2例,恶性肿瘤2例。生物固定型髋关节66髋,混合型17髋,骨水泥型9髋。术前彩色超声多普勒证实双下肢无深静脉血栓形成,术后早期(2～5h)开始进行主动规律锻炼,行跖趾关节伸屈、双侧距小腿关节伸屈内外翻运动;术后一两天行双距小腿关节环转运动;术后3～7d做距小腿关节环转运动,股四头肌等长收缩运动;术后8～14d在以上的基础上根据个人情况适当加大运动量。同时术后患者不使用任何抗凝药。①术后每日检查有无深静脉血栓形成的相应症状体征并于术后12d行双下肢彩色超声多普勒检查,与术前进行自身对照,观察血栓发生率。②术后不用抗凝药对出血情况的影响。结果:按意向处理分析,81例患者均进入结果分析。①患者术后下肢深静脉血栓发生率:术后深静脉血栓形成发生率为4.94%(4/81)。其中1例于术后4d出现患侧下肢肿胀,经彩超检查发现静脉和股浅静脉均出现栓子,3例无症状者均在术后12d复查时发现深静脉血栓形成,分别为静脉血栓1例,股浅静脉中段血栓2例。4例中股骨颈骨折骨水泥型全髋关节置换2例,非骨水泥型1例;骨性关节炎混合型全髋关节置换1例。病因为股骨颈骨折病例的深静脉血栓形成发生率为10.34%(3/29),术中应用骨水泥的病例发生率为11.54%(3/26)。②患者术中术后出血量:平均总出血量为(779.6±207.4)mL。67%(54/81)的患者无需输血。结论:①本文结果表明全髋关节置换术后早期进行主动规律的功能锻炼,其深静脉血栓形成发生率显著低于国内1999年曾有报道的全AIM： To observe the efficacy of active regular exercises as early as possible in the prevention of deep venous thrombosis （DVT） after total hip replacement.METHODS： Eighty-one patients undergoing total hip replacement from February 2000 to April 2004 were selected in the Department of Orthopedics, the Second Affiliated Hospital of Sun Yat-sen University, including 34 cases of aseptic necrosis of femoral head, 29 of femoral neck fracture, 8 of osteoarthritis, 4 of coax rebuild, 2 of old coxotuberculosis, 2 of ankylosing spondylitis, and 2 of malignant tumor; otherwise, there were 66 hips of bio-fixation type, 17 hips of mixed type, and 9 hips of bone cement type.Pre-operative color Doppler showed that there was no DVT in both lower limbs. Active regular exercise was performed at 2-5 hours after operation,including flexion and extension of metatarsophalangeal joints, inversion, eversion, flexion and extension of bilateral ankle joints; Circumduction of bilateral ankle joint was performed at 1-2 days after operation; Circumduction of ankle joint and isometric contraction of quadriceps femoris were performed at 3-7 days after operation; According to the individual condition, amount of motion was increased based on those mentioned above. No anticoagulant drugs were used in patients after operation. ①Whether there were symptoms related to DVT or not was detected every day after operation, and color Doppler of bilateral lower limbs was performed at 12 days after operation. The results were compared with those before treatment. Incidence of thrombosis was measured. ② Whether there were any changes in bleeding of patients without administration of anticoagulant drug was observed after operation.RESULTS： According to the intention-to-treat analysis, 81 patients were all involved in the result analysis. ①lncidence of lower-limb DVT： Incidence of DVT was 4.94%（4/81） after operation. Four days after operation,1 case was found having swelling of affect lower limb, and emboli in popliteal vein and superfic

关 键 词：深静脉血栓形成 关节成形术 置换 髋 身体锻炼 术后深静脉血栓形成 混合型全髋关节置换 术后早期 功能锻炼 发生率 彩色超声多普勒检查 预防 

分 类 号：R683.42[医药卫生—骨科学] R687.4[医药卫生—外科学]