抗凝并早期被动活动预防膝关节置换后深静脉血栓  

Effect of Preventing Deep Vein Thrombosis After Total Knee Arthroplasty Using Anticoagulation and Continuous Passive Motion

作　　者：黄小强[1] 廖永华[1] 巩四海[1] 康汇[1] 

机构地区：[1]西安市红十字会医院中西医结合骨科,710054

出　　处：《美中国际创伤杂志》2010年第3期23-26,共4页U.S.Chinese International Journal of Traumatology

基　　金：西安市科技攻关项目（No.SF200304）

摘　　要：目的：寻找人工膝关节置换术后下肢深静脉血栓形成（Deep Venous Thrombosis，DVT）的最佳预防方案，评价围手术期抗凝并早期持续被动活动（Continuous Passive Motion，CPM）对人工膝关节置换术后深静脉血栓形成的预防作用。方法：2002年1月～2005年12月对接受人工膝关节置换术者280例（均为单侧关节置换）根据围手术期处理方法的不同，采用分层随机化的方法前瞻性地分成空白对照组（对照组，n=70）、单纯抗凝组（抗凝组，n=70）、单纯早期被动活动组（CPM组，n=70）和抗凝＋CPM锻炼治疗组（观察组，n=70）。手术后第4天观察各组患者下肢的肿胀情况，并行术侧下肢彩色多普勒血管检查，诊断DVT。统计各组中DVT的发生率，采用SPSS11．0统计分析软件进行统计学分析。结果：抗凝组术后DVT发生率25．7％，CPM组30．0％，观察组12．9％，对照组45．7％，经统计学检验，观察组术后DVT发生率明显低于其它各组（P〈0．05）。结论：围手术期抗凝并早期被动活动对人工膝关节置换术后深静脉血栓形成具有明显的预防作用。Objective： To evaluate the efficacy and safety of perioperative use of anticoagulation and continuous passive motion for preventing deep vein thrombosis after total knee arthroplasty. Methods： From January 2001 to December 2005, we performed total knee arthroplasty for 280 patients （280 joints）, 149 male and 131 female, with an average age of 64.8±18.4 years ranging from 49 to 85 years. The patients were randomly divided into 4 groups according to treatment of perioperative： the control group （n=70）use nothing to preventing deep venous thrombosis （DVT）, the anticoagulation group （n=70） use low molecular weight heparin （LMWH） to preventing DVT, the CPM group （n=70） exercised themselves by continuous passive motion 8 hours after operation, the treatment group （n=70） use LMWH and CPM at the same time. The total cases were observed in their lower limbs after 4 days of operation. Color Doppler ultrasonography was used to detect DVT. Using SPSSll.0 Stat. software analyzed the DVT quantity in each groups. Results： DVT occurred in 25.7% of the antieoagulation group, in 30.0% of the CPM group, the reduction was significant （P〈0.05）eompared to the controlled group. DVT occurred in 12.9% of the observed group, the reduction was significant （P〈0.05） compared to antieoagulation or CPM group. Conclusion： Using anticoagulation and CPM can obviously prevent deep vein thrombosis after total joint arthroplasty.

关 键 词：运动疗法 持续被动性 关节成形术 置换 并发症 预防 

分 类 号：R687.42[医药卫生—骨科学]