多模式预防措施对老年关节置换术后静脉血栓栓塞症发生及转归的影响

目的分析采用多模式血栓预防措施后，老年初次髋、膝关节置换术后静脉血栓栓塞症（VTE）的发生和转归情况。 方法回顾性收集2015年1月至2017年6月行初次单侧髋、膝关节置换的老年患者375例（年龄≥60岁），所有患者均接受抗凝药物、足底小腿静脉气压泵、加强踝泵和早期下地等康复预防以及减少围手术期脱水等多模式血栓预防措施，术后采用彩色多普勒超声检查双侧下肢深静脉血栓（DVT）的发生情况，对有症状患者行肺动脉CT造影排查肺动脉栓塞（PE）。 结果共349名患者获完整随访，随访率92.5%。随访期间无症状性PE，DVT共38例，总发生率为10.9%，均为远端DVT。手术同侧DVT 38例，双侧3例。症状性DVT共27例（27/38，71.1%），无症状性DVT 11例（11/38，29.0%）。单纯腓肠肌间静脉血栓29例，单条小腿静脉血栓3例，混合静脉血栓6例。接受不同手术方式的患者DVT发生率差别有统计学意义（χ²=0.000，P<0.001），其中接受全膝关节置换手术患者DVT的发生率为16.3%，显著高于单髁关节置换手术组的4.7%。单纯腓肠肌间静脉血栓未予药物治疗，其他DVT口服利伐沙班抗凝治疗4 w。术后8 w，有26例（26/38，68.4%）血栓完全消融，12例（12/38，31.6%）血栓未完全消融，但所有DVT相关临床表现均消失，无残留血栓后遗症，且无血栓进展或新发PE。 结论采取多模式预防措施后，老年关节置换术后VTE发生率低，且均为远端DVT，经观察或短程抗凝治疗，症状消失并无后遗症。

Incidence and outcome of postoperative venous thromboembolism in elderly patients underwent knee or hip arthroplasty with multimodal thromboprophylaxis

ObjectiveTo analyze the incidence and outcome of postoperative venous thromboembolism in elderly patients underwent knee or hip arthroplasty with multimodal prophylaxis. Methods375 patients were enrolled retrospectively from January, 2015 to July, 2017. All the patients were older than 60 years and underwent unilateral primary knee or hip arthroplasty. A multimodal thromboprophylaxis program were employed, including low molecular heparin and Rivaroxaban for chemoprophylaxis, ankle pump, walking in early phase and pneumatic compression for physical prophylaxis. Color Doppler ultrasonography was used for screening the deep venous thrombosis (DVT) and CT pulmonary artery angiography was utilized for screening pulmonary embolism (PE). The follow-up was carried out for 8 weeks. Results349 patients had been fully followed up, the following rate was 92.5%. The overall VTE incidence was 10.9% (38/349), with no PE case and 38 distal DVT cases. There were 35 ipsilateral DVT cases and 3 bilateral cases. The incidence of symptomatic DVT was 71.1% (27/38) and asymptomatic was 29.0% (11/38). There were 29 cases with simple gastrocnemius venous thrombosis, 3 cases with calf vein thrombosis in one leg, and 6 cases with combined vein thrombosis. The DVT incidences in patients underwent different surgeries were significantly different (χ²=0.000, P<0.001). TKA group's DVT incidence is 16.3% much higher than UKA group. No medicine was held on those simple gastrocnemius venous thrombosis cases. The other DVT patients were prescribed Rivaroxaban for 4 weeks. All DVT patients were symptom-free and with no post-thrombotic syndrome or progressive DVT and PE. ConclusionsWith multimodal thromboprophylaxis, the overall VTE incidence in elderly underwent knee or hip arthroplasty is low and the presented ones were distal VTE. After short-term prognosis or short-term, symptoms disappeared with no sequela.