术前血浆D二聚体水平对全膝关节置换术后下肢深静脉血栓形成的预测

Prediction of Deep Vein Thrombosis after Total Knee Arthroplasty with Preoperative D-Dimer Plasma Measurement

目的:探讨术前三天血浆D-二聚体水平是否与人工全膝关节置换术(TKA)术后病人下肢深静脉血栓(DVT)的发生相关。方法:89名拟行TKA的病人在术前三天时行血浆D二聚体检测。在术后并未接受预防性抗凝措施。在术后6-10天左右予以双下肢血管彩超,如果在术后更早期出现临床症状,则立即予以双下肢血管彩超检查。结果:89名行TKA手术病人均在术前行血浆D二聚体检测。术后在46名(52%)的病人的血管彩超中发现DVT。以500ng/ml为临界值,D二聚体对DVT发生预测的敏感性,特异性,阳性和阴性值分别为59%,47%,56%,和51%。结论:此研究结果表明术前血浆D二聚体无法对TKA术后DVT进行预测。

Objective： To investigate the relationship between the level of D-dimer in plasma and the development of DVT in patients undergoing TKA. Methods： Eighty-nine consecutive patients undergoing TKA were detected in a preoperative clinic there days prior the surgery and had blood taken for measurement of plasma D-dimer. After surgery, they did not receive prophylaxis anticoagulant. Vascular ultrasotmd of both lower extremities was performed in all cases between the 6th-10th postoperative days or earlier if clinical symptoms occurred. Results： Plasma D-dimer was detected preoperatively in 89 patients undergoing TKA. DVT was detected by Vascular ultrasound in 46 （52 %） patients. At a cutoff of 500 ng/ml, the sensitivity, specificity, positive and negative predictive values of the preoperative D-dirner concentration for the development of subsequent DVT were 59 %, 47 %, 56 %, and 51%, respectively. Conclusion： Preoperative plasma measurement of D-dimer concentration is not useful for predicting DVT in patient undergoing TKA.