关节置换后下肢静脉血栓形成及髋膝关节病变中彩色多普勒超声的应用价值

Color Doppler ultrasound application in deep vein thrombosis formation and hip/knee osteoarthrosis following artificial joint replacement

目的:评价超声在人工关节置换后下肢深静脉血栓形成及髋膝骨关节病变中的临床应用价值。方法:检索中国生物医学文献数据库(CBM)、中文学术期刊全文数据库(CNKI),收集1993/2010发表的所有关于彩色多普勒超声用于关节置换后下肢深静脉血栓的自身对照和随机对照实验及高频超声检查膝骨关节病变的随机对照(或半随机对照)研究。排除重复性研究和Meta分析。结果:髋膝关节置换,共得到721例,756个行彩色多普勒超声检查下肢深静脉血栓的髋(膝)关节,膝骨关节病,共得到17个对照研究,1591个膝关节。所有研究均未描述是否采用了分配隐藏或盲法。结果显示:彩色多普勒超声诊断人工关节置换后下肢静脉血栓的敏感性好,特异性强。类风湿关节炎的超声特点以滑膜增厚为主,膝骨性关节炎以软骨及骨质破坏为主。结论:彩色多普勒超声能清楚观察关节置换后下肢深静脉血栓及静脉瓣膜功能,可作为髋膝关节置换前后监测下肢深静脉血栓形成的首选方法,可以对血栓进行随访观察,对于指导临床诊断和治疗提供可靠的依据。其敏感性强,特异性高,也为髋膝骨关节及周围软组织情况的临床诊断和治疗提供客观依据。

OBJECTIVE： To evaluate the clinical application value of ultrasound in deep vein thrombosis （DVT） formation and hip knee osteoarthrosis following artificial joint replacement. METHODS： A computer-based online search of CBM and CNKI was performed for self-control and randomized controlled trials regarding DVT formation following artificial joint replacement, as well as hip and knee osteoarthrosis using color Doppler ultrasound published between 1993 and 2010. Repetitive studies and Meta analysis were excluded. RESULTS： A total of 721 cases undergoing hip or knee joint replacement were involved, and 756 hip （knee） joints were subjected color Doppler ultrasound examination. A total of 17 control studies were collected, involving 1 591 knee joints. All studies did not describe allocation concealment or blind methods. Results show that color Doppler ultrasound is sensitive and specific in examination of DVT following artificial joint replacement. Ultrasound feature of rheumatoid arthritis is mainly characterized by thickened synovial membrane, and knee osteoarthritis is characterized by cartilage and bone destruction. CONCLUSION： Ultrasound can clearly observe DVT and venous valve function following joint replacement, and can serve as the first choice for monitoring DVT before and after hip/knee joint replacement to observe thrombus to provide reliable evidence for clinical diagnosis and treatment. In addition, ultrasound examination is highly sensitive and specific and therefore can provide objective evidence for diagnosis and treatment of hip, knee joint and surrounding soft tissues.