人工髋关节置换术后并发有症状下肢深静脉血栓临床分析

目的：探讨有症状下肢深静脉血栓（DVT）的发生率、临床特点及药物预防DVT的可行性。方法：2006年1月～2009年12月行人工髋关节置换术232例，术后连续腹壁脐周皮下注射低分子肝素钙4000U／d×10d，口服阿司匹林1片／d×30d。其中13例分别于术后第3～9天先后出现术侧下肢循环障碍临床表现，结合下肢深静脉彩超或下肢深静脉造影检查，均确诊为有症状下肢DVT，并立即行取栓术治疗。结果：13例患者行取栓术后，临床症状消失，Homans征和Neuhof征转为阴性。2例患者术后伤口渗出增加，细菌培养阴性，停用低分子肝素钙后伤口渗出减少，至术后2周伤口完全愈合。出院后随访1．5个月，再次行下肢深静脉彩超或下肢深静脉造影，未发现有血栓形成。结论：术前和术后患肢发生不明原因的肿痛时，应警惕下肢DVT的存在。早期诊断DVT，早期手术，并规范应用抗凝剂，联合早期功能锻炼，可以有效的防治下肢DVT。

Clinical Analysis on 13 Cases with Symptomatic Deep Vein Thrombosis of Lower Extremity after Hip Arthroplasty

Objective：To discuss the incidence rate and clinical features of symptomatic deep venous thrombosis （DVT） of lower extremity as well as the feasibility of drug to prevent DVT. Methods：From Jan. 2006 to Dec. 2009, 232 patients were operated on hip arthroplasty. Postoperative continuous low molecular weight heparin 4000U was injected in abdominal subcutaneous wall daily for 10 days and oral treatment of aspi- rin for one month. Among which, 13 cases were diagnosed with lower extremity of DVT by the clinical symptoms and signs combined with the results of the deep venous ultrasonography or deep venous angiograpby after operation from 3 - 9 days. Embolectomy surgery was done immediately after diagnosis. Results： The clinical symptoms and sings disappeared and the Homans sign and Neuhof sign were both negative after embolectomy surgery. Two patients＇ wound exudation increased, whose wound exudation decreased after stopping using low molecular weight heparin. Through bacterial culture, bacteria were not detected in wound exudation. The wounds were completely healed 2 weeks later. No spinal hematoma and no bleeding were found. A 1.5 months follow - up was carried out after discharge with deep venous uhrasonography or deep venous angiography again, 13 cases were revealed no thrombosis. Conclusions ： When the occurrence of unexplained swelling of postoperative limb, attention should be paid to the presence of DVT of lower extremity. As long as the early diagnosis DVT, which combined with early embolectomy, standardized application of anticoagulants and early exercise, DVT of lower limbs can be effectively controlled.