全髋置换后深静脉血栓的预防

Prevention of deep-vein thrombosis following total hip arthroplasty

目的:比较低分子肝素和吲哚美辛对预防全髋置换后深静脉血栓发生的疗效。方法:选择北京世纪坛医院骨科收治的股骨头无菌坏死患者120例,男62例,女58例,年龄38～82岁,平均66.9岁;均计划行全髋置换。全部患者随机分为3组,对照组(n=41):没有接受抗凝预防治疗;低分子肝素组(n=40):接受低分子肝素治疗,以患者的体质量计算,给予皮下注射范围1900～3800U/d;吲哚美辛组(n=39):接受吲哚美辛治疗,剂量为2次/d,口服25mg/次,均从置换前1d至出院当天。对比观察各组患者全髋置换后深静脉血栓的发生情况。结果:120例患者在全髋置换后第1周行彩色多普勒超声检查,发现65例患者有深静脉血栓(54%),其中18例深静脉血栓发生在非手术侧肢体。在手术侧肢体发生深静脉血栓的患者中18例有临床症状(28%),在非手术侧肢体发生深静脉血栓的患者均未见临床症状。对照组深静脉血栓的发生率为71%,明显高于低分子肝素组48%和吲哚美辛组45%(P<0.05)。结论:全髋置换前应用低分子肝素或吲哚美辛明显降低了深静脉血栓发生。

OBJECTIVE： To compare the efficacy of low-molecular-weight heparin and indomethacin for the prevention of deep-vein thrombosis after total hip arthroplasty. METHODS： 120 patients with aseptic necrosis of the femoral head underwent total hip arthroplasty in Department of Orthopedics, Beijing Shijitan Hospital, including 62 males and 58 females, aged 66.9 years （range 38-82 years）. They were randomly divided into 3 groups： control group （n=41）, who received no prophylaxis with anticoagulant; low-molecular-weight heparin group （n=40）, who received the low-molecular-weight heparin according to body mass （1900-3800 IU per day）; and indomethacin group （n=39）, who received indomethacin, 25 mg once, twice a day. The administration was started from 1 day before total hip arthroplasty. Deep-vein thrombosis after total hip arthroplasty in two groups was compared. RESULTS： 120 patients underwent color Doppler ultrasonography 1 week after total hip arthroplasty： 65 patients developed deep-vein thrombosis （54%）, and 18 were found in the limbs not undergoing surgery. Of the patients with deep-vein thrombosis in the surgery limbs, 18 had clinical symptoms （28%）. The prevalence of deep-vein thrombosis was 71%i n the control group, significantly greater than the heparin （48%） and indomethacin （45%） groups （P 〈 0.05）. CONCLUSION： Heparin or indomethacin administration prior to total hip arthroplasty significantly reduces the prevalence of deep-vein thrombosis.