人工全髋置换术中拉钩对下肢深静脉血栓影响的研究

Study of the influence of retractors on deep veins thrombus of lower limbs in total hip replacement

目的:通过对髂外动静脉及股动静脉与髋臼解剖学与临床的研究,探讨在全髋臼置换术中拉钩在髋放置位置对下肢深静脉血栓的影响。方法:通过解剖学研究56具成年骨盆标本中髂外动静脉及股动静脉来源及走行、与髋臼的关系进行测量分析;并通过临床观察22例(股骨颈骨折12例、股骨头缺血性坏死6例、类风湿性关节炎4例)在人工全髋置换术(THR)中拉钩放置安全区,经下肢静脉超声多普勒检查观察下肢深静脉血栓发病率。结果:在左侧3-5点间、右侧7-9点、左侧9点、右侧3点使用拉钩用力要适度,牵拉时间过长,会造成臀下血管、股动脉的牵拉过度或时间过长,易引起下肢深静脉血栓;通过临床22例THR拉钩放置安全区的观察,无一例下肢深静脉血栓,仅有2例轻度深静脉血流缓慢、但无明显的症状体征,经过口服活血通络中药后消失。结论:通过解剖学与临床观察研究,确定在THR中拉钩放置位置、深度是避免下肢深静脉血栓的重要因素。

Objective： To explore the position of retractors on acetabulum in avoiding the lower limbs thrombus based on the anatomical and clinical study of external iliac vessel, femoral vessel, obturator nerve, sciatic nerve and acetabular. Methods： The origins and course of external iliac vessel, femoral vessel and their relationship with the acetabulum in 56 adult pelvic specimens were measured and analyzed. The safe position and the depth of retractors on acetabulum in THR were observed in 22 cases（fractures of femoral neck in 12 eases, avascular necrosis of the femoral head in 6, rheumatoid arthritis in 4）. The incidence of the deep veins of lower limb thrombus were detected with ultrasonic. Results： The depth and strength of retractors on the left 3- 5 dot, 9 dot and right 7-9 dot, 3 dot must be careful. Excessive dragging or dragging blood vessel of breech and femoral artery for long time will result in the lower limbs thrombus. No lower limbs thrombus was found in 22 eases, only 2 eases of which had retarded blood flow without obvious symptoms and signs. Conclusion： The safe position and depth of retractors placed on acetabulum in THR is an important factor in avoiding the lower limbs thrombus.