OCM入路微创小切口全髋关节置换术后的深静脉血栓发生率

背景：OCM入路微创小切口全髋关节置换术（THA）创伤小、恢复快,理论上可降低DVT的发生率,但目前尚缺乏术后早期影像学检查判定DVT发生率的确切报道。目的：对行OCM入路微创小切口的全髋关节置换患者进行术后常规深静脉造影检查,以明确其深静脉血栓发生率并指导临床血栓预防。方法：行单侧OCM入路微创小切口THA患者27例,男13例,女14例;年龄28-90岁,平均（63.4±16.4）岁;BMI为21.2-29.8 kg/m2,平均（24.9±2.42）kg/m2;其中股骨头坏死9例,股骨颈骨折7例,发育性髋关节发育不良（DDH）6例,髋关节骨关节炎3例,强直性脊柱炎2例。术后行利伐沙班及气压泵治疗。评估手术时间、手术切口长度、肢体长度差异、术后下地行走时间、术后VAS评分（术后1、3 d）、术中和术后出血情况、术中和术后输血情况。股骨颈骨折患者术前及所有患者术后3-5d行双下肢深静脉造影,以明确DVT发生情况。结果：手术切口长8-10 cm,平均（8.5±0.6）cm;手术时间为65-125 min,平均（82±13）min;术中出血量为100-350 ml,平均（225±72）ml;术后引流量为120-905 ml,平均（457±218）ml,共4例患者输血。所有患者术后当天即可进行主动屈髋锻炼,双下肢长度差异均〈1 cm,术后1、3 d的VAS评分分别为0-6分,平均（2.5±1.4）分和0-4分,平均（1.9±1.2）分,所有患者术后2-3 d即可站立或行走。术前7例股骨颈骨折患者中2例发现患侧下肢DVT,术后深静脉造影检查仍提示同侧DVT,其余25例患者术后仅1例股骨颈骨折患者提示健侧腓肠肌静脉丛血栓形成。结论：采用OCM微创小切口手术入路THA可明显降低DVT的发生率。

Incidence of deep vein thrombosis after total hip arthroplasty with OCM minimal invasive technique

Background： Minimally invasive total hip arthroplasty（THA） by anterolateral approach（OCM technique） has small trauma,quick recovery and theoretically low incidence of deep vein thrombosis（DVT）. However, the accurate incidence of DVT by radiological examination is still lacking.Objective： To identify the incidence of venographic DVT after THA with OCM technique and to provide guidance for the prevention of thrombus.Methods： TTotally 27 patients（13 males and 14 females） with unilateral OCM technique were enrolled in the study. There were 9 cases with avascular necrosis of femoral head, 7 with femoral neck fracture, 6 with developmental dysplasia of the hip, 3 with osteoarthritis of the hip and 2 with ankylosing spondylitis. The mean age of the patients was（63.4±16.4） years（ranging from 28 to 90 years） and the mean BMI was（24.9±2.42） kg/m2（ranging from 21.2 to 29.8 kg/m2）. Rivaroxaban and intermittent pneumatic compression were used after THA. The operation time, length of incision, discrepancy of lower limb, time for weight-bearing, VAS score at day 1 and day 3 postoperatively, transfusion and blood loss during and after THA were evaluated. The DVT were assessed by bilateral venography in the patients with femoral neck fracture preoperatively and in all patients 3 to 5 days postoperatively.Results： The mean length of incision was（8.5±0.6） cm（ranging from 8 to 10 cm）. The mean operation time was（82±13） min（ranging from 65 to 125 min）. 4 patients received transfusion. The blooding loss during was（225±72） ml（ranging from 100 to 350 ml） and the postoperative drainage was（457±218） ml（ranging from 120 to 905 ml）. Blood was transfused in 4 pa-tients. Active hip flexion exercise was achieved in all the patients. The discrepancy of lower limb was less than one centimeter. The mean VAS score on day 1 and day 3 postoperatively was 2.5±1.4（0 to 6） and 1.9±1.2（0 to 4）. All the patients can afford weight-bearing in 2 to 3 days after THA. Two