早期康复介入对全膝关节置换术后深静脉血栓的影响  

Effect of early rehabilitation on the decrease of deep vein thrombosis after total knee arthroplasty

作　　者：姚尧[1] 徐兴全[1] 戎朕 宋凯[1] 周允超 陈东阳[1] 徐志宏[1] 史冬泉[1] 戴进[1] 张成绩[1] 蒋青[1] YAO Yao XU Xingquan RONG Zhen SONG Kai ZHOU Yunchao CHEN Dongyang XU Zhihong SHI Dongquan DAI Jin ZHANG Chengji JIANG Qing(Department of Sports Medicine and Adult Reconstruction, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China)

机构地区：[1]南京大学医学院附属鼓楼医院运动医学与成人重建外科,南京210008

出　　处：《中国骨与关节外科》2016年第4期326-330,共5页Chinese Journal of Bone and Joint Surgery

基　　金：国家杰出青年科学基金项目(81125013);临床新技术安全性与效果评价--关节置换术安全性与效果评价(201302007)

摘　　要：背景:下肢深静脉血栓(DVT)是全膝关节置换术(TKA)常见并发症之一。如何有效预防TKA术后急性期的血栓形成仍然是一个棘手的问题。目的:评估早期康复介入对预防TKA术后DVT形成的影响。方法:2011年7月至2013年3月,行初次TKA的125例患者被纳入研究。康复组57例,由一名经验丰富的康复医师制定围手术期康复计划并执行;对照组68例,由专业护理人员宣教并嘱患者自行完成,并无康复医师介入执行方案。所有患者均由同一组医师行TKA,并于术后3~5 d接受下肢深静脉造影,比较两组的术后血栓发生率以及分布有无差异。结果:125例患者中术后造影确认血栓20例,近端2例,远端18例。康复组3例,发生率为5.2%:对照组17例,发生率为25%,两组比较有统计学意义(x^2=8.987,P=0.003)。血栓分布比较中,康复组中2例累及肌间静脉,1例累及腓静脉和肌间静脉:对照组中9例为孤立的肌间静脉血栓,4例为腓静脉合并肌问静脉血栓,2例累及胫后静脉、腓静脉以及肌间静脉,2例胭静脉、腓静脉、胫后静脉及肌间静脉。近端血栓2例,远端血栓18例。结论:早期康复介入可以有效降低TKA术后急性期的血栓发生率并影响血栓的分布。Background：Deep vein thrombosis（DVT） is one of the most common complications after total knee arthroplasty（TKA）.And how to decrease the incidence of DVT effectively after TKA is still a thorny issue.Objective：To evaluate the effect of early rehabilitation on the decrease of DVT after TKA.Methods：A total of 125 patients undergoing primary TKA between July 2011 and March 2013 were enrolled into our study and divided into rehabilitation group（n=57） and control group（n=68）.An experienced rehabilitation physician set a perioperative rehabilitation program for the patients of rehabilitation group.Conventional postoperative education was carried out by nurses in control group.All TKAs were performed by the same surgery group and patients accepted venography 3-5 d postoperatively.The incidence and anatomical distribution of DVT were compared between two groups.Results：Overall,20 DVTs were identified by venography in the 125 patients,including 18 distal and 2 proximal ones.They were identified in 3 patients（5.2%） in the rehabilitation group and in 17 patients（25%） in the control group,which showed a significant difference（x-2=8.987,P=0.003）.In the rehabilitation group,2DVTs located in muscular veins,and one involved in peroneal vein combined with muscular veins.In the control group,9DVTs involved in muscular veins,4 involved in peroneal vein combined with muscular vein,2 involved in posterior tibial vein,peroneal vein and muscular vein,another 2 cases involved in popliteal vein,peroneal vein,posteriortibial vein and muscular vein.Conclusions：Early rehabilitation can decrease the incidence of DVT effectively and affect the distribution in the acute stage after TKA.

关 键 词：关节成形术 置换 膝 康复 深静脉血栓形成 血管造影术 

分 类 号：R687.4[医药卫生—骨科学]