关节置换后的深静脉血栓形成

背景：关节置换后形成深静脉血栓发病的概率为40%~60%，而深静脉血栓容易出现肺栓塞并发症而危及生命，死亡率高达20%~30%。 目的：对骨科关节置换后下肢深静脉血栓形成的病因与治疗及并发症肺栓塞的治疗进展进行阐述。 方法：以“关节置换，静脉栓塞，肺栓塞，病因，预防，治疗”为关键词应用计算机检索2000/2010万方数据库和中国期刊全文数据库。 结果与结论：关节置换后下肢深部静脉血栓形成的病因及发病机制有着多方面的因素，深静脉血管壁损伤，血流缓慢和高凝状态是静脉血栓形成的3个因素。患者的全身状况差，合并其他疾病，关节置换手术创伤，手术麻醉方法，手术时间延长，肢体固定以及长期卧床都是下肢深静脉血栓形成的高危因素。下肢深静脉栓塞和肺栓塞是导致关节置换后患者高致残率和高死亡率的主要原因。临床医生应于术前对关节置换患者形成深静脉血栓的危险因素进行系统评估，并采取相应措施，最大限度降低其发生率。

Deep vein thrombosis after arthroplasty

BACKGROUND: The incidence of deep vein thrombosis (DVT) after knee replacement is 40% to 60%. The mortality of DVT-induced pulmonary embolism (PE) is 20% to 30%. OBJECTIVE:To expatiate the etiology and treatment of lower extremity DVT following knee replacement as well as DVT-induced PE. METHODS:A computer search of Wanfang and CNKI databases were retrieved for articles published between 2000 and 2010 using the keywords of “knee replacement, vein thrombosis, pulmonary embolism, etiology, prevention, treatment”. RESULTS AND CONCLUSION:Deep vein wall injury, slow blood flow and hypercoagulable state are three factors for vein thrombosis. High risk factors for lower extremity DVT include poor condition, other diseases, surgical trauma due to joint replacement, anesthesia method, operative time, fixation way and long-term bed rest. Lower extremity DVT and PE are the cause of high mobility and mortality in patients following joint replacement. Clinicians should perform a systematic assessment for DVT to take appropriate measures to minimize DVT incidence.