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膝关节镜术后下肢深静脉栓塞情况分析

吴疆   

  1. 天津市天津医院
  • 收稿日期:2010-09-17 修回日期:2010-12-27 出版日期:2011-03-15 发布日期:2011-03-15
  • 通讯作者: 吴疆

  • Received:2010-09-17 Revised:2010-12-27 Published:2011-03-15 Online:2011-03-15

摘要: 摘要 背景:下肢深静脉栓塞是关节外科手术后常见和主要的并发症,特别是在膝、髋关节置换术后。在我院膝关节镜手术比关节置换手术更为普遍。但是,关于关节镜术后病人发生深静脉栓塞的风险从未有人提及。目的:明确膝关节镜术后病人下肢深静脉栓塞的发生率。方法:设定一组膝关节镜病人进行此项研究。列入研究的病人均未在术前进行预防血栓的治疗。病人在术后1周进行术侧下肢静脉多普勒检查。检测出术后深静脉栓塞的发生率,并评估发生下肢深静脉栓塞的危险因素。结果:本组184个病人在术后全部进行了下肢静脉多普勒检查。33个病人检测出下肢深静脉栓塞。(17.9%;95% 可信区间,12.7-24.3%)。在这33个病人当中,9个病人检出下肢大静脉栓塞,(4.9%; 95%可信区间, 2.3%-9.1%)。没有病人出现肺栓塞。在检出的病人33个当中,仅有20个病人(60.6%)有症状,13个病人 (39.4%)没有症状。应用止血带超过60分钟的病人发生下肢深静脉栓塞的风险性明显增高。结论:研究结果显示17.9%的病人在膝关节镜术后发生了深静脉栓塞(既有大静脉也有小静脉)。研究表明膝关节镜术后病人下肢深静脉栓塞的发生率与一些因素相关,因此下肢深静脉栓塞的发生率确实可以减少在关节镜手术的病人当中。

关键词: 深静脉栓塞, 关节镜, 止血带

Abstract: ABSTRACT Background Deep vein thrombosis is a common, important complication of major orthopedic surgery, particularly knee arthroplasty. Knee arthroscopy is performed more frequently and in our hospital than knee arthroplasty. However, the true risk of deep vein thrombosis in patients who undergo this procedure is unknown. Objective To determine the incidence of deep vein thrombosis after knee arthroscopy in a large cohort of patients. Methods Consecutive patients scheduled for knee arthroscopy were eligible for the study. Enrolled study patients received no thromboprophylaxis. They were underwent unilateral Doppler examination approximately 1 week after their operation. The primary outcome measure was the incidence of venous thromboembolism. Risk factors for deep vein thrombosis were evaluated. Results Among the 184 patients who had unilateral Doppler examination, deep vein thrombosis was detected in 33 (17.9%; 95% confidence interval, 12.7%-24.3%). Of these, 9 were proximal (4.9%; 95% confidence interval, 2.3%-9.1%). No patient died presented with clinically suspected pulmonary embolism. Of 33 patients, only 20 (60.6%) with deep vein thrombosis had symptoms while 13 (39.4%) were asymptomatic. The risk of deep vein thrombosis was significantly higher among patients who had a tourniquet applied for more than 60 minutes. Conclusions The results of our study demonstrate that 17.9% of patients develop deep vein thrombosis after knee arthroscopy (most being either proximal or extensive). Several factors were analyzed as potential risk factors for venous thrombosis. It is reasonable to perform a randomized trial to determine whether the incidence of deep vein thrombosis can be safely reduced in patients undergoing knee arthroscopy.

Key words: Key word, Deep vein thrombosis, knee arthroscopy, tourniquet