全髋关节置换术围手术期深静脉血栓形成防治的临床研究

目的 探讨全髋关节置换术围手术期深静脉血栓形成（DVT）的治疗措施.方法 回顾性分析300例行人工全髋关节置换术患者的临床资料.所有患者入院时均常规检测凝血功能,术后第1,3,5天监测D-二聚体（D-D）水平.疑似DVT患者,行下肢彩色多普勒超声检查,诊断不明确时行静脉造影.全部患者均接受物理治疗和预防性抗凝治疗.结果 术前共诊断DVT20例（30侧肢体）,中心型7例,周围型13例.所有患者进行术前抗凝治疗后,非DVT患者D-D水平呈逐渐下降趋势;DVT患者第1天和第3天D-D仍维持在高水平状态,平均D-D分别为6500,6800 μg/L.其他280例全髋关节置换术病例中共发现40例DVT.其中周围型DVT患者术后继续抗凝治疗6个月,中心型或混合型DVT患者骨科手术后放置临时腔静脉滤器,所有患者围手术期均未出现严重并发症.结论 全髋关节置换术患者术前需要充分监测评估,术后需早期进行功能锻炼,并联合抗凝治疗预防DVT.

Clinical study on prevention of peroperative period deep vein thrombosis after total hip replacement

Objective To explore the treatment measures of peroperative period deep vein thrombosis （DVT） after total hip replacement.Methods The clinical data of 300 patients who were treated by total hip replacement were analyzed retrospectively.All patients were given conventional detection of coagulation status.The level of D-dimer （D-D） was detected after operation for 1,3,5 d.The patients who suspected with DVT were checked lower limb by color Doppler ultrasonography.If the diagnosis was not clear,the venography was took.All patients were treated with physical therapy and anticoagulation therapy.Results Twenty patients （30 limbs） were diagnosed with DVT before operation,7 patients were central type,13 patients were peripheral type.All patients underwent preoperative anticoagulation,the level of D-D in non-DVT patients was decreased.The level of D-D in DVT patients in the first and third day kept at high level and were 6500,6800 μ g/L.After operation,40 patients were diagnosed with DVT.The peripheral type DVT patients were treated with continued anticoagulation for 6 months,the central type or mixed type DVT patients were treated by temporary vena cava filter,all patients had no severe complications during peroperative period.Conclusions The operation of total hip replacement need sufficient assessment and monitoring during peroperative period.Postoperative early functional exercise and anticoagulation therapy may be given to prevent DVT.