人工髋关节置换后深静脉血栓形成影响因素的回顾分析

Retrospective analysis of deep venous thrombotic risk factors in prosthetic hip surgery

背景：目前尚缺少严格遵照《中国骨科大手术静脉血栓栓塞症预防指南》进行血栓预防的大宗人工髋关节置换后深静脉血栓栓塞症发生情况的报道。目的：调查人工髋关节置换患者在进行规范预防性抗凝治疗后下肢深静脉血栓的发生情况。方法：纳入2005-01/2010-07于北京协和医院骨科接受人工髋关节置换的患者,对置换后出现下肢深静脉血栓形成者进行回顾性分析,包括高危因素、预防措施、症状特点、治疗方案及转归。结果与结论：共纳入670例人工髋关节置换患者,其中16例发生下肢深静脉血栓,11例为人工股骨头置换患者,5例为单侧全髋关节置换患者。诊断分布为股骨颈骨折14例,股骨头无菌性坏死1例,血友病性关节炎1例。其合并症1~4个,包括高血压、糖尿病、类风湿性关节炎、慢性肾功能不全等。围手术期皆应用规范物理、药物疗法预防下肢深静脉血栓形成。14例表现为下肢肿胀、疼痛;2例以肺栓塞为首发症状。多数预后良好;1例死于与下肢深静脉血栓形成无关的肺部感染,1例抗凝治疗后并发脑出血导致植物生存状态。提示进行规范预防治疗可以降低下肢深静脉血栓形成发生率,但仍不能完全杜绝其发生。髋部骨折、长期卧床、高龄、代谢性内科疾病仍是下肢深静脉血栓形成的高危因素。

BACKGROUND： It is rarely reported that the occurrence of deep venous thromboembolism after artificial hip replacement in the patients group which is strictly complied with ＂China’s major orthopedic surgery venous thromboembolism prevention guidelines＂ for thromboprophylaxis. OBJECTIVE： To investigate the morbidity of deep venous thrombosis （DVT） in patients who underwent artificial hip replacement for standard prophylactic anticoagulant therapy. METHODS： The data of patients who underwent artificial hip replacement from Department of Orthopedics, Peking Union Medical College Hospital were selected. Then patients who occurred DVT after replacement were retrospective analyzed involving the risk factors, preventive measures, symptomatic characters, treatments and prognoses. RESULTS AND CONCLUSION： Totally 670 patients who underwent artificial hip replacement were selected including 16 patients with DVT, eleven patients with artificial femoral head replacement and five patients with unilateral total hip arthroplasty. The diagnoses included： 14 cases for femoral neck fracture, 1 case for avascular necrosis of femoral head, 1 case for hemophilia arthritis. The number of comorbidity was 1 to 4 in a patient, including hypertension, diabetes, rheumatoid arthritis, chronic renal failure and so on. All patients underwent standard mechanical and pharmacological thromboprophylaxis. Fourteen cases developed with swelling and pain in lower leg, and 2 cases developed with pulmonary embolism as the first symptom. Most patients recovered well. One patient of pulmonary embolism died of pulmonary infection which had no correlation with DVT, one patient of pulmonary embolism developed complication of cerebral bleeding after thrombolysis, which lead to persistent vegetative state. It is indicated that DVT morbidity can be reduced but can not eliminated by standard thromboprophylaxis. Hip fracture, long-lasting bed rest, aged, and co-existing medical diseases are the high-risk factors of DVT.