膝、髋关节置换术后近端静脉血栓的特点  

The characteristics of proximal deep vein thrombosis after total knee and hip arthroplasty

作　　者：姚尧[1] 戎朕 薛龙[1] 乔梁[1] 杨献峰[2] 徐兴全[1] 宋凯[1] 戴小宇[1] 谌业帅 陈东阳[1] 徐志宏[1] 史冬泉[1] 戴进[1] 蒋青[1] 

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,210008 [2]南京大学医学院附属鼓楼医院放射科,210008

出　　处：《中华骨科杂志》2017年第6期360-367,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81271945）

摘　　要：目的探讨人工关节置换术后近端静脉血栓形成的临床特征。方法收集2007年5月至2016年10月髋、膝关节置换术后经下肢深静脉造影或彩色多普勒超声确诊的近端静脉血栓40例患者的资料，其中男9例，女31例；年龄38~86岁，平均67岁；体重指数16.94~31.25 kg/m^2，平均24.3 kg/m^2。膝关节置换组11例，髋关节置换组29例。记录近端静脉血栓的分布、长度、影像学特征、临床症状，并比较年龄、性别、手术侧别、手术类型、术前诊断，血栓发现时间对近端血栓分布的影响。结果40例，下肢深静脉造影确诊31例，彩超诊断9例；根据累及部位2例仅限于近端静脉，38例近端血栓同时合并远端，膝、髋关节置换两组的近端静脉血栓是否连续性以及孤立性分布差异无统计学意义。近端静脉血栓长度2~35 cm，平均（8.85±9.31）cm；膝关节置换组长度为（5.0±2.05）cm，髋关节置换组（10.31±10.55）cm，两组的差异有统计学意义。40例中累及股静脉及以上部位13例均为髋关节置换组，膝关节置换组，近端血栓均累及腘静脉，手术类型（膝/髋）及疾病类型（股骨颈骨折/其他）对近端血栓分布的影响有统计学意义，其他因素对近端血栓分布无统计学意义。本组40例中，25例（62.5%）在下肢深静脉造影或彩色多普勒超声检查前接受血栓症状、体征的评估，对比9例膝关节置换组及16例髋关节置换组的患肢肿胀、疼痛评分、Homans征、Neuof征的差异无统计学意义。结论髋膝关节术后近端静脉血栓多合并远端静脉血栓并与之呈连续性分布，手术类型以及疾病对近端血栓的分布有影响，髋关节置换术后及术前诊断为股骨颈骨折者更容易累及股静脉及以上部位。Objective To analyze the characteristics of proximal deep vein thrombosis （DVT） after total joint arthroplas- ty. Methods 40 cases of proximal DVT were collected from May 2007 to October 2016 which were all diagnosed by lower limb venography or sonography. There were 9 males and 31 females aged from 38 to 86 years, average 67 years, and body mass index was from 16.94 to 31.25kg/m^2, with an average of 24.3 kg/m^2. 29 cases of THA patients and 11 cases of TKA patients. The anatomi- cal distribution, size, radiological performance, local physical findings were recorded and multivariable analysis was performed to evaluate the relationship between distribution of proximal DVT and related parameters including age, gender （male/female）, side of leg（left/right）, surgery type（knee and hip）, preoperative diagnosis（femoral neck fracture/other disease）, time of diagnosis with DVT （during hospitalization/after discharge）. Results Among 40 proximal DVT cases, 31 cases diagnosed by phlebography and 9 cas- es were diagnosed by ultrasound. 2 cases were isolated proximal DVT while 38 cases connected with distal DVTs. 9 cases of blood clots in the proximal and distal thrombosis connected discontinuously. There was no isolated proximal DVT in TKA group and 10 cases {90.9%） of blood clots in the proximal and distal thrombosis connected continuously while there ~ere 2 cases （6.9%） isolated proximal DVTs in THA group and 21 （77.8%） of blood clots in the proximal and distal thrombosis connected discontinuously, and there was no statistic significant difference between the two groups. The average length of proximal was 8.85±9.31cm （range from 2-35cm） with 5.0±2.05 em in TKA group and 10.31±10.55 cm in THA group. A significant difference was found between the 2 groups （P=0.014）. 13 cases located in femoral veins and upper venous region which were all from THA group. There was a signifi- cant difference in the distribution between surgery type and preoperative diagnosis. However, there was no s

关 键 词：关节成形术 置换 静脉血栓形成 静脉造影术 

分 类 号：R687.4[医药卫生—骨科学]