髋关节置换患者围手术期功能锻炼预防下肢深静脉血栓形成

下肢深静脉血栓形成(deep venous thrombosis,DVT)是骨科手术后的常见并发症之一.Kim[1]报道关节置换术后DVT发生率为25%,吕厚山等[2]报道髋关节置换(THA)术后为40.0%.国外调查表明,未采取预防措施的骨科大手术深静脉血栓形成的发生率为50%,我国上海为30% [3～7].目前,骨科临床护理中虽对卧床患者采取了不同程度地预防DVT的措施,但没有系统的护理功能锻炼方案,重视了术后预防,忽略了术前预防,没有起到早期预防的作用.2007年10月～2009年1月笔者对87例行THA的患者在围手术期进行科学、多种形式、系统的功能锻炼,做到早期预防,积极有效地减少了DVT发生.现将指导患者进行功能锻炼的体会总结如下.     

人工膝关节置换术后下肢深静脉血栓患者的临床特征和高危因素

目的 了解人工全膝关节置换术(total knee arthroplasty,TKA)后症状性下肢深静脉血栓(deep vein thrombosis,DVT)患者的临床特点及高危因素.方法 回顾性研究2015-07至2020-06北京积水潭医院收治的8162例TKA患者临床资料,记录术后出现症状性DVT及继发的肺动脉...     

骨科手术围术期患者下肢深静脉血栓防护体会

下肢深静脉血栓（DVT）是骨科手术的常见并发症,可严重危害病人生命和健康。本文通过术前正确使用弹性长腿袜、合理功能锻炼、加强患肢护理、进行健康教育以及围术期麻醉管理、预防性用药等进行预防和护理取得了良好效果。     

加速康复外科理念在膝关节置换术围术期应用

目的评价加速康复(ERAS)外科理念在膝关节置换术围术期的应用疗效。方法收集2015年1月至2016年1月收治的因膝关节骨性关节炎行膝关节置换术的82例患者,随机分为ERAS组(n=40)和常规组(n=42),比较两组围手术期疗效。结果患者82例随访1个月。所有患者切口均一期愈合,术后12 d拆线。ERAS组术中出血量、输血量均明显少于常规组,差异有统计学意义(P<0.05)。两组手术时间比较,差异无统计学意义(P>0.05)。ERAS组术后住院(8.0±3.4)d,明显低于常规组的(11.5±3.6)d,两组平均住院日比较,差异有统计学意义(P<0.05)。两组均未发生切口并发症。两组深静脉血栓、泌尿系统感染并发症发生率比较,差异无统计学意义(P>0.05)。比较术后12 d和术后1个月的膝关节KSS评分,ERAS组膝关节KSS评分优于常规组,差异有统计学意义(P<0.05)。结论 ERAS外科理论在膝关节置换围术期的应用能明显缩短术后住院时间和住院费用,可以促进患者膝关节功能的康复,值得推广和应用。     

下肢单一骨折后围手术期深静脉血栓发生率及部位分析

目的分析下肢单一骨折后围手术期深静脉血栓(DVT)形成率与骨折部位、血管位置的相关性。方法回顾性分析2013年1月-2017年12月汉中市中心医院创伤骨科收治1 107例下肢单一骨折患者,其中男性438例(39.6%),女性669例(60.4%);平均年龄68.1岁(18~91岁)。观察患者手术前后双下肢静脉超声结果,并分析不同静脉部位DVT与围手术期症状性肺栓塞(PE)的相关性。结果 1107例中发生DVT 789例(71.3%),术前确诊326例(29.4%),其中近端DVT 42例(3.8%),远端284例(25.7%);术后确诊463例(41.8%),其中近端DVT 65例(5.9%),远端398例(36.0%)。术后DVT发生率显著高于术前(41.8%vs.29.4%,P<0.05),远端静脉DVT发生率显著高于近端静脉(61.6%vs.9.7%,P<0.05)。术前骨折同侧下肢和骨折对侧下肢DVT发生率与术后比较差异无统计学意义(P>0.05),但术后双侧下肢DVT发生率显著高于术前(13.6%vs.3.3%,P<0.05)。术前骨折对侧下肢近端静脉DVT发生率与术后比较差异无统计学意义(P>0.05),但术后骨折对侧下肢近端静脉DVT发生率显著高于术前(15.7%vs.4.7%,P<0.05)。症状性PE发生率为1.4%(16/1107),近端静脉DVT患者PE发生率显著高于远端静脉DVT患者(11.2%vs.0.6%,P<0.05)。结论下肢单一骨折患者术后DVT发生率高于术前,尤其是术后双侧下肢DVT发生率升高。DVT主要位于远端静脉、且症状性PE发生率较低,但近端静脉DVT患者的症状性PE发生率较高。     

骨科围手术期深静脉血栓形成的预防及护理进展

为了提高护理人员对骨科手术病人并发下肢深静脉血栓形成(DVT)的认识,加强对骨科高危人群的预防及护理,降低DVT的发生率.现就预防及护理方面的研究进展作一综述.     

腔静脉滤器植入预防肺动脉栓塞发生的围手术期护理

肺动脉栓塞是肢体深静脉血栓(Deep vein thrombosis,DVT)形成后的严重合并症.竹中秀裕[1]统计935例肺动脉栓塞,因DVT所致为72%.国内研究表明[2],在DVT患者中,45%可以发生肺动脉栓塞.近年来随着上述观点逐渐被人们接受,作为预防肺动脉栓塞发生的重要手段-腔静脉滤器(以下为滤器),已被广泛应用于临床,1998～2007年底我院为140例患者植入滤器,现将临床护理报告如下.     

血栓弹力图在脑部肿瘤术后凝血功能异常患者输血中的应用效果

目的 研究血栓弹力图在凝血功能异常患者输血中的应用效果.方法 将2015年1月-2016年1月脑部肿瘤手术后出现凝血异常的患者100例,通过随机分组,分为对照组与观察组,每组50例.对照组采用临床常规输血,观察组采用血栓弹力图检测输血.对比两组患者的输血后凝血情况、输血后采用血栓弹力图检测的结果.结果 观察组在根据血栓弹力图结果输血后,患者的凝血情况好于对照组(P＜0.05).观察组在输血后经血栓弹力图检测,其各项指标均好于对照组(P＜0.05).结论 在脑部肿瘤术后,使用血栓弹力图检测患者实际情况然后进行输血,可以改善血凝异常患者的输血情况,提高患者的血液使用情况,增加患者的血凝质量,提高康复效果,值得临床推广.     

三位一体共管模式在骨科大手术患者围术期静脉血栓栓塞症预防中的应用

目的:探讨三位一体共管模式在骨科大手术患者围术期静脉血栓栓塞症（VTE）预防中的应用效果。方法:采用回顾性病例对照研究分析2019年1月至2019年8月温州医科大学附属第二医院收治的120例行骨科大手术患者临床资料,其中男46例,女74例;年龄43～89岁［（63.7 ± 11.3）岁］。骨折类型：股骨转子间骨折58例...     

Thrombosis of the deep cerebral veins: CT and MRI findings with pathologic correlation

Deep cerebral vein thrombosis can present with acute, severe neurological symptoms and may be rapidly fatal as in the 20-year-old woman reported here. Although MRI is superior for establishing the diagnosis, CT is usually the first examination performed in the clinical setting. It is therefore important to recognise certain indicators such as extensive bithalamic low density. These and certain other less specific signs are correlated with the MRI and autopsy findings. Received: 14 October 1996 Accepted: 7 February 1997     

Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE): Outcomes at 12 months

ObjectiveTo determine the safety and effectiveness of vena cava filters (VCFs).MethodsA total of 1429 participants (62.7 ± 14.7 years old; 762 [53.3% male]) consented to enroll in this prospective, nonrandomized study at 54 sites in the United States between October 10, 2015, and March 31, 2019. They were evaluated at baseline and at 3, 6, 12, 18, and 24 months following VCF implantation. Participants whose VCFs were removed were followed for 1 month after retrieval. Follow-up was performed at 3, 12, and 24 months. Predetermined composite primary safety (freedom from perioperative serious adverse events [AEs] and from clinically significant perforation, VCF embolization, caval thrombotic occlusion, and/or new deep vein thrombosis [DVT] within 12-months) and effectiveness (composite comprising procedural and technical success and freedom from new symptomatic pulmonary embolism [PE] confirmed by imaging at 12-months in situ or 1 month postretrieval) end points were assessed.ResultsVCFs were implanted in 1421 patients. Of these, 1019 (71.7%) had current DVT and/or PE. Anticoagulation therapy was contraindicated or had failed in 1159 (81.6%). One hundred twenty-six (8.9%) VCFs were prophylactic. Mean and median follow-up for the entire population and for those whose VCFs were not removed was 243.5 ± 243.3 days and 138 days and 332.6 ± 290 days and 235 days, respectively. VCFs were removed from 632 (44.5%) patients at a mean of 101.5 ± 72.2 days and median 86.3 days following implantation. The primary safety end point and primary effectiveness end point were both achieved. Procedural AEs were uncommon and usually minor, but one patient died during attempted VCF removal. Excluding strut perforation greater than 5 mm, which was demonstrated on 31 of 201 (15.4%) patients’ computed tomography scans available to the core laboratory, and of which only 3 (0.2%) were deemed clinically significant by the site investigators, VCF-related AEs were rare (7 of 1421, 0.5%). Postfilter, venous thromboembolic events (none fatal) occurred in 93 patients (6.5%), including DVT (80 events in 74 patients [5.2%]), PE (23 events in 23 patients [1.6%]), and/or caval thrombotic occlusions (15 events in 15 patients [1.1%]). No PE occurred in patients following prophylactic placement.ConclusionsImplantation of VCFs in patients with venous thromboembolism was associated with few AEs and with a low incidence of clinically significant PEs.     

Thrombosis of the popliteal vein

Among 3,307 consecutive patients (3,556 legs) with deep venous thrombosis, 54 (1.5%) showed an isolated thrombus of the popliteal vein on phlebography. The majority of those had a history of “effort” or long lasting flexion during air or bus travel. Forty-four percent suffered from pulmonary embolism as the first sign of deep venous thrombosis. Functional phlebography demonstrated the primary site of thrombosis at folds forming in the vein wall at flexion. In order to further elucidate the pathogenetic mechanism, 158 popliteal veins were examined phlebographically in different functional states revealing age-related characteristic wall patterns of rings and folds in flexion causing transient impairment of flow. Complementary morphological studies of 120 popliteal veins during autopsy showed a transverse rippling of the vein wall caused by intimal fibrosis and partial atrophy of the media corresponding to the phlebographic findings. It is concluded that microtrauma during effort in combination with impaired venous backflow and fibrotic transformation of the venous wall can lead to thrombus formation in the popliteal vein.     

Thrombosis of the right vein of Labbé: radiological and clinical findings

Summary A rare case of aseptic thrombosis of the right vein of Labbé in a young woman is reported. Cerebral venous thrombosis was suggested by computed tomography and confirmed by angiography. Mild left-sided neurological deficits resolved almost completely. The combination of a nonspecific clinical picture with an atypical lesion on CT may favour the diagnosis of cortical venous thrombosis.     

新疆克州静脉血栓栓塞症的危险因素及发病特征分析

目的研究克州静脉血栓栓塞症（VTE）的危险因素和发病特征。 方法分析我院近3年收治的VTE患者的临床资料。根据是否与住院及手术相关,分为医院相关性VTE（HA VTE）和社区相关性VTE（CA VTE）。调查患者的VTE危险因素,分析不同部位类型的下肢深静脉血栓形成（DVT）合并下腔静脉血栓或肺血栓栓塞症（PTE）的差异。 结果共纳入81例VTE患者,其中CA VTE 63例,HA VTE 18例,前者是后者的3.5倍。CA VTE的危险因素以肥胖（28.57%）、创伤或骨折（19.05%）、卧床（17.46%）为主,尚有15.87%的病例未能明确危险因素。HA VTE的危险因素以外科手术（66.67%）为主,其中又以骨科（6例）、妇产科手术（2例）最为常见。左下肢、右下肢、双侧下肢DVT的构成比分别为62.96%、34.57%、2.47%,差异有统计学意义（P < 0.05）。合并PTE的概率,双侧下肢DVT为100%,右下肢为32.14%,左下肢为13.72%,差异有统计学意义（P < 0.05）。 结论克州地区CA VTE较HA VTE常见,前者的主要危险因素是肥胖、创伤或骨折、卧床,后者为外科手术,并以骨科、妇产科手术最为常见。     

Catheter-Directed Thrombolysis of Acute Deep Vein Thrombosis in the Lower Extremity of a Child with Interrupted Inferior Vena Cava

We present the case of a 14-year-old girl who developed acute deep vein thrombosis (DVT) in her right lower extremity. Laboratory testing revealed protein S deficiency, and the patient’s father also had this abnormality with a history of lower extremity DVT. Manual thromboaspiration followed by catheter-directed thrombolysis resulted in total clearance of all thrombi. Computed tomography and later venography revealed an interrupted inferior vena cava. Catheter-directed thrombolysis is an established treatment for adults with acute DVT. To the best of our knowledge, this report is the first to describe catheter-directed thrombolysis in a pediatric patient with lower extremity DVT. Our results suggest that catheter-directed thrombolysis is safe and effective for use in selected older children and adolescents with acute DVT in the lower extremity.     

二维彩色多普勒超声诊断下肢深静脉血栓形成的评价

目的：探讨二维彩色多普勒超声显像对下肢深静脉血栓形成的诊断价值。方法：对临床疑诊下肢深静脉血栓形成患者90例，118条病肢，应用二维彩色多普勒超声检测下肢深、浅静脉管壁、管径及周围结构，血栓部位、大小、范围，彩色血流变化，检测静脉瓣功能。结果：二维彩色多普勒超声共检出阳性患者41例，53条病肢。中心型12条（22．6％），周围型25条（47．2％），混合型16条（30．2％）。病肢左右侧之比3．1：1（P＜0．001）。结论：诊断下肢深静脉血栓形成二维彩色多普革超声具有特异性表现，在其病因及危险因素判定方面可以起到筛选作用，可作为下肢不明原因肿胀的首选方法。同时在观察病程演变及对静脉瓣功能影响等方面，具有其他影像检查方法不可替代的优势。     

CT Venography for Deep Vein Thrombosis Using a Low Tube Voltage (100 kVp) Setting Could Increase Venous Enhancement and Reduce the Amount of Administered Iodine

Objective

To investigate the validity of the 100 kVp setting in CT venography (CTV) in the diagnosis of deep vein thrombosis (DVT), and to evaluate the feasibility of reducing the amount of administered iodine in this setting.

Materials and Methods

After receiving the contrast medium (CM) of 2.0 mL/kg, 88 patients underwent CTV of the pelvis and lower extremities by using one of four protocols: Group A, 120 kVp setting and 370 mgI/mL CM; group B, 120 kVp and 300 mgI/mL; group C, 100 kVp and 370 mgI/mL; group D, 100 kVp and 300 mgI/mL. The groups were evaluated for venous attenuation, vein-to-muscle contrast-to-noise ratio (CNR_VEIN), DVT-to-vein contrast-to-noise ratio (CNR_DVT), and subjective degree of venous enhancement and image quality.

Results

Venous attenuation and CNR_VEIN were significantly higher in group C (144.3 Hounsfield unit [HU] and 11.9), but there was no significant difference between group A (118.0 HU and 8.2) and D (122.4 HU and 7.9). The attenuation value of DVT was not significantly different among the four groups, and group C had a higher absolute CNR_DVT than the other groups. The overall diagnostic image quality and venous enhancement were significantly higher in group C, but there was no difference between groups A and D.

Conclusion

The 100 kVp setting in CTV substantially help improve venous enhancement and CNR_VEIN. Furthermore, it enables to reduce the amount of administered iodine while maintaining venous attenuation, as compared with the 120 kVp setting.     

血常规指标对老年急诊骨盆及下肢骨折手术患者术后深静脉血栓形成的影响及预测价值分析

目的 分析血常规指标对老年急诊骨盆及下肢骨折手术患者术后深静脉血栓(DVT)形成的影响及预测价值。方法 回顾性分析2020年6月至2022年2月洛阳市东方人民医院收治的82例急诊行骨盆及下肢骨折手术治疗的老年患者的临床资料,收集患者性别、年龄等一般资料以及术前白细胞计数(WBC)、红细胞计数(RBC)等血常规资料,并根据术后是否出现DVT将其分为DVT组与非DVT组,分析血常规指标对老年急诊骨盆及下肢骨折手术患者术后DVT形成的影响及预测价值。结果 82例急诊行骨盆及下肢骨折手术治疗的老年患者中,19例(23.17%)患者术后出现DVT,设为DVT组;63例(76.83%)患者术后未出现DVT,设为非DVT组。多因素Logistic回归分析结果显示,RBC、中性粒细胞计数(NEU)为老年急诊骨盆及下肢骨折手术患者术后DVT形成的影响因素(95%CI为1.411～7.553、 1.450～5.476,P=0.006、 0.003)。受试者操作特征(ROC)曲线分析结果显示,当RBC、 NEU的截断值分别为4.05×10¹²/L、 6.40×10⁹     

The trajectory of the centre of pressure during barefoot running as a potential measure for foot function

The main purpose of this study was to describe and interpret the COP trajectory during barefoot running in a large cohort of young adults with no history of injury. COP data were collected from 215 subjects, who ran at 3.3 m s⁻¹ over a 16.5 m long track, with a built in Footscan^® pressure platform. COP data were filtered using a 50 Hz lowpass butterworth filter and normalised. Reliability was then studied and mean curves were calculated for medial–lateral displacement (COP_x) and velocity (v_xCOP), anterior–posterior displacement (COP_y) and velocity (v_yCOP) as well as for the resultant velocity (v_xyCOP). Displacement and velocity of the COP provided insight over functional foot behaviour. A medially oriented peak in v_xCOP was found, which may reflect the fast initial pronation. A laterally oriented second peak in v_xCOP, together with a second peak in v_yCOP, indicated a fast forward shift of the COP over the lateral border of the foot during forefoot contact phase. During the forefoot push off phase, at the level of the metatarsals, anterior velocities of the COP were low and reflected the importance of the forefoot during push off. Finally, the COP course was studied for high arch, normal and low arch feet and indicated, a more lateral COP course for the low arch feet.