中西药物预防人工髋关节假体置换后下肢深静脉血栓形成

背景：药物治疗和物理疗法对人工髋关节假体置换后下肢深静脉血栓形成的预防和治疗有积极作用。 目的：探讨中西药物预防人工髋关节假体置换后下肢深静脉血栓形成的疗效。 方法：收集中药和西药预防人工髋关节假体置换后下肢深静脉血栓形成的相关文献,分析不同药物对下肢深静脉血栓的作用机制,比较中药和西药在治疗和预防人工髋关节假体置换后下肢深静脉血栓形成的疗效及安全性。 结果与结论：磺达肝癸钠在预防骨科大手术后总深静脉血栓形成的作用大于依诺肝素,利伐沙班在减少关节置换后患者隐性失血量方面优于低分子肝素。中药在人工髋关节假体置换后下肢深静脉血栓形成的预防上选用益气活血和改善血液循环的方法,如活血通脉汤、桃红四物汤等,还有补阳还五汤、佛手通瘀汤、活血通栓饮、加味桃核承气汤等,在下肢深静脉血栓预防和治疗效果方面均较好。中西药的比较研究中发现,中药或中西药联合对预防人工髋关节假体置换后下肢深静脉血栓形成与西药效果相同,且安全性较高。     

全髋关节置换后下肢深静脉血栓形成的4项危险因素

背景：下肢深静脉血栓形成是人工全髋关节置换常见的也是危险性较大的并发症,如果不能提前预防,会造成严重后果,故在临床中需要对下肢深静脉血栓形成的危险因素进行评估。 目的：评估人工全髋关节置换后下肢深静脉血栓形成的临床危险因素。 方法：对2010年1月至2013年2月在北京大学深圳医院骨关节科行人工全髋关节置换的162例患者资料进行回顾性分析,所有患者均在置换前、置换后第3天和第7天进行双下肢深静脉彩超检查。采用Logistic回归分析统计法分析全髋关节置换患者下肢深静脉血栓发生的危险因素。 结果与结论：入选Logistic回归模型的因素为骨水泥假体、年龄分布、体质量指数、全身麻醉,它们的OR值分别是9.215,11.247,3.842,4.825,是下肢深静脉血栓发生的危险因素。提示骨水泥假体的使用、高龄、体质量指数大于25 kg/m2及全身麻醉均是全髋关节置换后发生下肢深静脉血栓形成的危险因素,应引起临床重视,积极采取对应措施。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

髋关节置换后药物预防深静脉血栓的分组对照

背景：术后深静脉血栓形成是髋关节置换患者围手术期的危险并发症之一,药物治疗是预防血栓形成的有效方法,临床上正逐步规范用药方案,以取得最佳的预防效果。 目的：探索置换后预防血栓的规范化治疗措施。 方法：回顾分析固原市人民医院骨科2010-01/2011-05接受髋关节置换者110例,应用低分子肝素、磺达肝癸钠、利伐沙班及华法林防治深静脉血栓的临床资料,用药方案根据《中国骨科大手术静脉血栓栓塞症预防指南(2009版)》的要求。将上述临床结果与2007-01/2009-12接受骨科髋关节置换后不规律用药者123例的临床资料比较分析。 结果与结论：所有患者均无因注射抗凝药物而产生明显不适症状。两组中均有少量病例在置换后出现不同深静脉血栓临床症状。不规律用药组和规律用药组D-二聚体检测分别有45,29例阳性。不规律用药组与规律用药组的深静脉血栓主要发生在置换后4周内,随着置换后用药时间的延长,血栓发生率出现下降趋势。置换后12周时规律用药组发生血栓人数明显低于不规律用药组(P < 0.05)。提示在髋关节置换后规律应用低分子肝素、磺达肝癸钠、利伐沙班及华法林可有效预防深静脉血栓的发生。     

老年单侧全髋关节置换与下肢深静脉血栓形成(英文)

背景:下肢深静脉血栓形成是全髋关节置换患者围手术期严重的并发症,其发生率较高。目前尚不清楚原发病对老年全髋关节置换后下肢深静脉血栓形成的影响。目的:观察不同原发病对老年全髋关节置换后下肢深静脉血栓形成的影响。方法:选择单侧全髋关节置换患者147例,年龄64~93岁,根据原发病不同分为2组:骨折组68例,置换前经历了创伤,均为股骨颈骨折患者;骨病组79例,术前未经历过创伤。根据患者生理年龄、置换前社会活动能力、骨质情况、预期寿命等选择全髋假体,其中采用生物学假体5例,混合型假体12例,其他全部采用骨水泥型假体。对术后出现患肢肿胀和/或疼痛,下肢伴有或不伴有Homans征/Neuhofs征阳性的患者常规应用加压超声技术进行超声多谱勒检查。结果与结论:骨折组置换后32例出现患侧肢体肿胀,伴有疼痛者20例,出现Homans征/Neuhofs征15例,经超声多普勒检查证实29例下肢下肢深静脉血栓形成阳性;股骨颈骨折后行全髋关节置换1例,无下肢深静脉血栓形成临床症状,于置换后17d猝死,尸检证实为伤侧下肢混合型下肢深静脉血栓形成合并肺栓塞;骨病组置换后20例出现患侧肢体肿胀,伴有疼痛者11例,出现Homans征/Neuhofs征9例,经超声多普勒检查证实20例下肢深静脉血栓形成阳性。股骨颈骨折患者比骨病组患者具有更高的血液凝固状态,下肢深静脉血栓形成发生率更高(P0.05)。提示股骨颈骨折是老年全髋关节置换后下肢深静脉血栓形成发生的高危因素。     

髋关节置换后下肢深静脉血栓形成的血液动力学改变

背景：髋关节置换后下肢深静脉血栓的早期诊断非常重要,对及时治疗及疗效判断也具有十分重要的意义。 目的：观察髋关节置换后并发下肢深静脉血栓患者的血液改变情况,为早期预测和干预提供参考。 方法：2009年1月至2014年9月收治60例髋关节置换患者,其中置换后并发下肢深静脉血栓者32例(下肢深静脉血栓组),未并发下肢深静脉血栓者28例(非下肢深静脉血栓组)。分别于置换后1,3,5 d检测患者的血流变指标改变情况。 结果与结论：通过检测显示,下肢深静脉血栓组置换后各种凝血标记物均异常高于非下肢深静脉血栓组,表明置换后患者的血液高凝状态度与下肢深静脉血栓的发生有密切相关的关系;而下肢深静脉血栓组置换后3,5 d D-二聚体、纤维蛋白原水平显著高于非下肢深静脉血栓组,说明D-二聚体、纤维蛋白原水平的增高与置换后发生下肢深静脉血栓呈正相关关系,提示对髋关节置换后应对患者进行动态的血液监测,如果各检测结果呈持续性增高,则应怀疑是否有血栓的发生,并及早采取预防措施。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

间歇性充气加压与髋关节置换后下肢深静脉栓塞的预防和治疗

目的:探讨间歇性充气加压治疗的应用特点及髋关节置换后下肢深静脉血栓预防和治疗。方法:应用万方数据库和中国期刊全文数据库(CNKI),以"髋关节置换,下肢深静脉血栓,间歇性充气加压,预防,治疗"为关键词,检索1980/2010时限内与间歇性充气加压治疗与髋关节置换后下肢深静脉栓塞的预防和治疗有关的文献。纳入与髋关节置换后下肢深静脉血栓形成因素及深静脉血栓预防措施相关的文献,排除重复研究或较陈旧文章。结果:依据纳入排除标准共保留相关文献23篇。髋关节置换后下肢深静脉血栓的形成主要与血液高凝状态、静脉血流缓慢、血管内皮损伤以及止痛泵的应用和心理因素等相关。深静脉血栓的好发部位集中在股静脉、腓肠静脉和小腿肌间静脉丛;好发时间则集中在髋关节置换后1～7d。间歇性充气加压治疗主要通过其机械效应及生物化学效应预防血栓形成。结论:间歇性充气加压对髋关节置换后的下肢深静脉栓塞的形成具有良好的预防作用,是一种安全、简便的物理疗法,但对高风险患者的治疗效果尚不能肯定,需结合药物行预防治疗,以获得较确切的治疗效果。     

髋部骨折患者术前下肢深静脉血栓发生率及高危因素

文题释义：髋部骨折：主要包括股骨颈骨折和股骨转子间骨折,患者常常需要行手术治疗。下肢深静脉血栓是髋部骨折患者围术期最常见的并发症之一,即使采用了低分子肝素等抗凝药物预防,下肢仍然常形成深静脉血栓。 深静脉血栓：是血液在深静脉内不正常的凝结,形成血栓,阻塞血管,导致血液回流受阻并且可引发静脉功能不全的一种疾病,深静脉血栓栓子脱落后流入肺动脉可导致肺栓塞以及下肢深静脉功能不全。 背景：髋部骨折患者围术期容易并发下肢深静脉血栓,但目前髋部骨折患者术前发生下肢深静脉血栓的研究较少,特别是对术前深静脉血栓形成的危险因素尚不明确。 目的：统计髋部骨折患者术前并发下肢深静脉血栓的发生率,探讨髋部骨折患者术前并发下肢深静脉血栓形成高危因素。 方法：回顾性分析2017年1月至2018年12月安徽医科大学第二附属医院收治的242例髋部骨折患者的病历资料,男99例,女143例,平均年龄69.1岁,其中股骨颈骨折189例,股骨转子间骨折53例。所有患者对治疗及试验方案均知情同意,且得到医院伦理委员会批准。所有患者均无抗凝禁忌,入院后予以低分子肝素预防性抗凝。常规双下肢行血管彩超检查,根据结果分为下肢深静脉血栓组、下肢非深静脉血栓组(下肢伴有深静脉血栓形成时术前行下腔滤器置入)。对患者的年龄、性别、骨折类型(股骨颈骨折和股骨转子间骨折)、受伤至手术时间、实验室检查(红细胞压积、纤维蛋白原、D-二聚体、血红蛋白)、合并慢性疾病(高血压、糖尿病)等可能的血栓形成危险因素进行单因素分析,再采用多因素分析Logistic回归分析确定其独立危险因素。结果与结论：①242例髋部骨折患者中58例(24%)发生下肢深静脉血栓;②下肢深静脉血栓组与下肢非深静脉血栓组的性别、骨折类型、D-二聚体水平、纤维蛋白原水平、合并慢性疾病(高血压、糖尿病)相比差异均无显著性意义(P > 0.05);2组患者的年龄、受伤至手术时间、血红蛋白水平比较,差异有显著性意义(P < 0.05);③多因素回归分析显示,年龄≥70岁,受伤至手术时间≥5 d是髋部骨折患者并发下肢深静脉血栓的独立危险因素;④说明髋部骨折患者即使在预防性抗凝药物治疗的情况下仍易发生深静脉血栓,其中高龄患者以及术前等待的时间长是其血栓形成的高危因素。 ORCID: 0000-0001-8379-9230(卫勇) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

全髋关节置换后对深静脉血栓的综合预防

背景：全髋关节置换后深静脉血栓高发,对患者危害很大,因此全髋关节置换后有必要寻找一种安全有效的预防方案来降低深静脉血栓的危害。 目的：观察综合预防方案对全髋关节置换后发生深静脉血栓的影响。 方法：将102例全髋关节置换患者随机分为观察组和对照组,每组51例。观察组采用综合预防方案,由序贯、交叉的联用低分子肝素、间歇式充气压力治疗及持续股神经阻滞镇痛3个干预措施有机组成;对照组由医生根据临床经验给予低分子肝素抗凝治疗,或者间歇式充气压力治疗。比较两组患者深静脉血栓发生及分布情况,同时统计血小板和血红蛋白情况。 结果与结论：观察组患者深静脉血栓阳性数3例,深静脉血栓发生率为6%;而对照组患者深静脉血栓阳性数11例,深静脉血栓的发生率为22%,两组相比差异有显著性意义(P < 0.05)。两组发生深静脉血栓患者深静脉血栓在近、远端静脉分布构成比上差异无显著性意义(P > 0.05)。两组患者置换后1 d血红蛋白值较置换前降低,差异有显著性意义(P < 0.05);两组患者置换后1 d血小板值较置换前有所降低,但差异无显著性意义(P > 0.05);两组患者置换后1 d和6 d之间的血红蛋白值及血小板值差异无显著性意义(P > 0.05)。提示由序贯、交叉的联用低分子肝素、间歇式充气压力治疗及持续股神经阻滞镇痛3个干预措施组成的综合预防方案可显著降低全髋关节置换后患者深静脉血栓的发生率,且无严重并发症,效果确切可靠。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

空气波压力治疗预防全膝关节置换后下肢深静脉血栓

背景：大量文献研究表明,空气波压力治疗在预防髋部大手术后下肢深静脉血栓形成中有重要作用。 目的：探讨空气波压力治疗仪对预防全膝关节置换后下肢深静脉血栓的效果。 方法：80例全膝关节置换患者随机数字表法均分为试验组和对照组,对照组行常规治疗与护理加个人行为功能锻炼,试验组在对照组基础上,置换后第2天采用空气波压力治疗仪治疗双下肢;比较两组患者患肢肿胀指数、凝血综合指数及发生下肢深静脉血栓的例数。 结果与结论：治疗后2周,试验组肿胀指数、凝血综合指数及发生下肢深静脉血栓的例数明显减少,其效果明显优于对照组,差异有显著性意义(P < 0.05)。全膝关节置换后早期应用空气波压力治疗仪能有效缓解患肢肿胀,改善凝血综合指数,改善患者的血凝状态,预防人工全膝关节置换后的下肢深静脉血栓形成。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

阿司匹林和利伐沙班预防全膝关节置换后下肢深静脉血栓形成

背景：现中国临床上常用抗凝药物为利伐沙班,但有效预防静脉血栓栓塞性疾病的同时,围手术期出血性并发症发生率也明显增加。有研究表明阿司匹林对深静脉血栓形成和肺栓塞具有良好预防效果,但对于能否将其作为全膝关节置换后预防静脉血栓栓塞性疾病的常规用药至今存在争议。 目的：观察比较阿司匹林和利伐沙班预防全膝关节置换后下肢深静脉血栓形成的疗效和安全性。 方法：初次行单侧全膝关节置换的324例骨关节炎患者随机等分为3组,于置换后12 h,分别用利伐沙班,低分子肝素,阿司匹林干预治疗14 d。所有患者均随访4周。 结果与结论：与低分子肝素组相比,利伐沙班组深静脉血栓发生率降低(P < 0.05),隐性失血量及切口并发症率升高(P < 0.05)。与低分子肝素相比,阿司匹林组深静脉血栓发生率、隐性失血量、切口并发症率、下肢肿胀率和皮下瘀斑率差异均无显著性意义(P > 0.05)。结果证实,利伐沙班拥有较强抗凝效果,但并发症发生率高。阿司匹林与低分子肝素相比疗效和安全性均无差异。阿司匹林作为全膝关节置换后多模式抗凝治疗的一部分,安全有效。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

Venous Thromboembolism in Korean Patients Undergoing Major Orthopedic Surgery: A Prospective Observational Study using Computed Tomographic (CT) Pulmonary Angiography and Indirect CT Venography

In patients undergoing major orthopedic surgery, data of deep venous thrombosis (DVT) and pulmonary embolism (PE) are lacking as studied by computed tomographic (CT) pulmonary angiography and indirect CT venography (CTPA-CTV). A prospective observational study was performed for 363 Korean patients undergoing major orthopedic surgery to determine the incidence of venous thromboembolism (VTE), especially proximal DVT and PE. The incidence of VTE was 16.3% (n=59). Of them, 8 patients (2.2%) were symptomatic. The rate of VTE was the highest in patients who underwent total knee replacement (40.4%), followed by hip fracture surgery (16.4%), and total hip replacement (8.7%; P<0.001). The incidence of PE was 6.6% (n=24). Of them, 4 patients (1.1%) were symptomatic. Forty-one patients (11.3%) were in the proximal DVT or PE group. Based on multivariate analysis, total knee replacement and age ≥65 yr were significant risk factors for proximal DVT or PE in patients undergoing major orthopedic surgery (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1-5.1; P=0.025; and OR, 2.1; 95% CI, 1.0-4.4; P=0.046, respectively). Taken together, the overall incidence of PE was 6.6% and rate of symptomatic PE rate was 1.1%. Knee joint replacement and age ≥65 yr were significant risk factors for proximal DVT or PE.     

Cost effectiveness of low-molecular weight heparin versus warfarin following hip replacement surgery.

Little information is available on the efficacy of low-molecular-weight heparin (enoxaparin) versus warfarin for treatment of deep vein thrombosis and pulmonary embolism following hip replacement surgery. Still less is known of the comparative cost effectiveness of these two therapies. A retrospective study was done on 56 patients who underwent elective hip surgery at an urban medical center between 1991 and 1996. All patients received enoxaparin or warfarin for purposes of thromboprophylaxis. An analysis of medication cost, therapy, laboratory monitoring, and bleeding events of the two antithrombolytic agents was undertaken. Total savings with enoxaparin averaged $1253 per patient, or $137,886 over the study period. The incidence of deep vein thrombosis or pulmonary embolism was 0% with enoxaparin and 3% with warfarin. These data indicate that enoxaparin is a more cost-effective and efficacious regimen for thromboprophylaxis following hip replacement surgery than warfarin.     

Thromboembolic disease after total knee replacement: Experience of 5100 cases

The aim of the study was to quantify the incidence and timing of venous thromboembolic events (VTE) after total knee replacement (TKR). Data from 5100 consecutive TKRs performed over 10 years were prospectively collected. Cases were reviewed to identify thromboprophylaxis given, the diagnosis of VTE, treatment and adverse outcomes. There were 3 deaths (0.059%) from pulmonary embolism (PE). Of 123 VTEs identified, 55 had PE, 17 had above knee deep vein thrombosis (DVT), 28 had calf DVT and 14 had been incorrectly coded as VTE. There was considerable inappropriate treatment of calf DVT with resultant morbidity. There was an increase in diagnosis of PE between days 1 and 5 post surgery in the later part of the study, corresponding with increasing use of CT Pulmonary Angiography. Increasing diagnosis of PE may be due to detection of embolic debris from surgery due to greater vigilance rather than post-operative thromboembolism. Death from PE is rare following TKR.     

Advancement of prophylaxis and therapy for venous thromboembolism

Recently in Japan, venous thromboembolism (VTE) [deep vein thrombosis (DVT)/pulmonary thromboembolism (PTE)] has increased with the Westernization of eating habits and aging of society. In the West, the prophylaxis guidelines have been discussed for many years. Unfortunately, Japan falls far behind the West in this area. Therefore, the necessity of thromboprophylaxis in Japanese people should be emphasized based on reliable VTE studies in Japan. In orthopedic surgery, prospective multicenter studies in Japan indicate that the incidence of DVT/PTE in total hip or knee replacement surgery and hip fracture surgery were almost equal to those in Western people. Furthermore, a multi-center, prospective epidemiological study in Japan revealed that the incidence of VTE following major abdominal surgery was 24.3%. We developed Japanese Guidelines for VTE prophylaxis based on the 6th ACCP guideline in 2004. The incidence of perioperative PTE in Japan has been investigated by the Japanese Society of Anesthesiologists since 2002. The rate of perioperative PTE was estimated to be 4.41 per 10,000 operations in 2002, and 4.76 in 2003; however, it decreased to 3.61 immediately after the guideline for thromboprophylaxis was issued and the management fee for PTE prophylaxis became covered by health insurance in April 2004. Furthermore, it markedly decreased in 2005. However, mechanical prophylaxis is not sufficient to prevent PTE, and advanced prophylaxis by anticoagulants, such as low-molecular-weight heparin/selective Xa inhibitor along with unfractionated heparin (UFH)/vitamin K antagonists (VKA) will be essential. The advanced revised guidelines for VTE prophylaxis based on our clinical evidence will be established in the near future. As for treatment for VTE, anticoagulant and thrombolytic therapies are essential. In cases with VTE, UFH followed by VKA (INR: 1.5-2.5) is standard. In cases of PTE with shock, thrombolytic therapy such as tissue plasminogen activator or urokinase, catheter intervention, or surgical procedures under pericutaneous cardiopulmonary support should be selected based on the severity of PTE.     

Activated protein C resistance, factor V Leiden and assessment of thrombotic risk

Venous thromboembolism comprises deep vein thrombosis (DVT) and pulmonary embolism (PE). Acute venous thromboembolism (VTE) is a serious and potentially fatal disorder which often complicates the course of hospitalized patients, but also affects ambulatory and otherwise healthy people. The annual incidence of venous thromboembolism is 1 to 2 cases per 1000 person and the risk of the disorder rises exponentially with age, from an annual rate of less than 5 per 100,000 children to greater than 400 per 100,000 adults older than 80 years.     

深静脉血栓形成的介入治疗

目的 探讨对深静脉血栓形成（DVT）的患者进行介入溶栓治疗的选择原则和并发症的预防。方法 38例DVT患者放置下腔静脉滤器后进行血管腔内治疗，包括静脉腔内插管溶栓术38例、球囊扩张术14例和支架放置术2例。48h照腹平片观察滤器的位置．1周后行彩色多普勒检查了解下腔静脉和病变深静脉的通畅度。出院后定期复查滤器位置和患肢情况。结果 髂静脉、锁骨下静脉和肱静脉DVT的完全缓解率为100％，股静脉DVT完全缓解率为93．3％，小腿静脉DVT为68．4％；其余为部分缓解。滤器放置成功率为100％，溶栓过程中及追踪复查均未发生肺动脉栓塞。结论 深静脉血栓形成的患者进行介入溶栓治疗结合下腔静脉滤器放置术有效而安全，有较高的临床应用价值。     

Venous Thromboembolism Following Hip and Knee Replacement Arthroplasty in Korea: A Nationwide Study Based on Claims Registry

The aim of this study was to examine the incidence and trends of clinically relevant venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) after hip and knee replacement arthroplasty (HKRA) in Korea. Between January 1 and December 31, 2010, 22,127 hip replacement arthroplasty (HRA) patients and 52,882 knee replacement arthroplasty (KRA) patients were enrolled in the analysis using the administrative claims database of the Health Insurance Review and Assessment Service (HIRA). All available parameters including procedure history and clinically relevant VTE during the 90 days after HKRA were identified based on diagnostic and electronic data interchange (EDI) codes. The overall incidence of VTE, DVT, and PE during the 90 days was 3.9% (n=853), 2.7% (n=597), and 1.5% (n=327) after HRA, while the incidence was 3.8% (n=1,990), 3.2% (n=1,699), and 0.7% (n=355) after KRA. The incidence of VTE after HKRA was significantly higher in patients who had previous VTE history (odds ratio [OR], 10.8 after HRA, OR, 8.5 after KRA), chronic heart failure (2.1, 1.3), arrhythmia (1.8, 1.7), and atrial fibrillation (3.4, 2.1) than in patients who did not. The VTE incidence in patients with chemoprophylaxis was higher than that in patients without chemoprophylaxis. The incidence of VTEs revealed in this retrospective review was not low compared with the results of the studies targeting other Asian or Caucasian populations. It may warrant routine prevention including employment of chemoprophylaxis. However, the limitation of the reviewed data mandates large scale prospective investigation to affirm this observation.     

Incidence of Deep Vein Thrombosis after Spinal Cord Injury in Korean Patients at Acute Rehabilitation Unit

Deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) remain significant causes of morbidity, mortality in patients with spinal cord injury (SCI). Since incidence of DVT after SCI in Korean population has not been much studied, we retrospectively analyzed the medical records of 185 SCI patients admitted for acute rehabilitation unit to investigate the incidence of DVT. Color Doppler ultrasonography was performed to screen for the occurrence of DVT at the time of initial presentation to acute rehabilitation unit. Primary study outcome was the incidence of DVT. Possible risk factors for DVT including the epidemiologic characteristics, completeness of motor paralysis, cause of injury, spasticity, surgery, and active cancer were analyzed. The incidence of DVT after SCI was 27.6%. In multiple logistic regression analysis, absence of spasticity was a significant independent risk factor (P<0.05) for occurrence of DVT. Symptomatic pulmonary embolism was evident in 7 patients without an episode of sudden death. Therefore, it is concluded that the incidence of DVT after SCI in Korean patients is comparable with that in Western populations. This result suggests that pharmacologic thromboprophylaxis should be considered in Korean patients with SCI.     

Controversial issues in the diagnosis of venous thromboembolism

Although considerable progress has been made in the diagnosis of venous thromboembolism, several issues remain that are awaiting a proper solution. Among them are: the respective role of compression ultrasound of the proximal veins and ultrasonography of the entire leg vein system in the diagnostic approach of patients with the clinical suspicion of the first episode of deep venous thrombosis (DVT) of the lower extremities; the safety of managing subgroups of patients with suspected DVT without objective tests, i.e., with the use of pre-test probability scores and D-dimer assays; the role of ultrasonography in the diagnostic approach of patients with suspected ipsilateral recurrent thrombosis; and the role of spiral CT in the diagnostic approach of patients with clinically symptomatic pulmonary embolism.     

小切口人工双极股骨头置换治疗高龄股骨颈骨折疗效分析

目的探讨人工双极股骨头置换术治疗高龄股骨颈骨折的临床疗效。方法2001年6月～2006年6月对49例GardenⅢ-Ⅳ型股骨颈骨折行人工双极股骨头置换术。结果按Harris人工髋关节置换疗效评定标准，治疗结果优30例，占61．2％；良12例，占24．4％；中5例，占10.2％；差2例，占4％；优良率85．6％结论高龄病员如一般情况较差、预期寿命有限、期望活动量小的股骨颈骨折是人工双极股骨头置换的适应症。