膝关节镜下交叉韧带重建术后下肢深静脉血栓的临床研究

The research of deep venous thrombosis after arthroscopic surgery of the cruciate ligament in the normal population

[目的]分析膝关节镜下交叉韧带重建术后不同术式下肢深静脉血栓的发生率,并探讨其原因。[方法]对2009年9月～20011年5月河北医科大学第三医院关节外科收治的282例膝关节交叉韧带损伤并接受韧带重建手术的患者进行统计研究,以彩色超声多普勒检查为诊断依据,分别于入院24 h内,术后第3 d,术后第7 d进行超声检查,统计不同术式术后下肢深静脉血栓的发生率,并分析止血带的使用时间与DVT发生的相关性。[结果]282例患者DVT总体发生率为12.06%。术后DVT的发生率分别为前交叉韧带手术7.24%,前交叉韧带合并内外侧结构修复(或重建)为12.77%,后交叉韧带手术为17.39%,后交叉韧带合并内外侧结构修复(或重建)为23.53%,前后交叉韧带同时重建伴(或不伴)内外侧结构修复(或重建)为25.00%。五组间比较差异具有显著性(P<0.05);止血带的使用时间在<90 min,90～120 min及>120 min患者中DVT的发生率分别为5.56%;12.77%和17.35%,三组间比较结果有显著性差异(P<0.05)。[结论]膝关节交叉韧带重建术后患者中DVT具有一定的发生率,后交叉韧带相关手术DVT发生率明显增高、长时间使用止血带亦会增加DVT的发生率。关节镜医师应对关节镜下韧带术后DVT的发生引起足够的重视,尤其是DVT发生率高、止血带使用时间长的术式,采取预防措施以防止意外发生。

[ Objective] The purpose of this study is to analyze the incidence of deep venous thrombosis with different arthroscopic surgical type of cruciate ligament and expose the reason. [ Method ] From September 2009 to May 2009,282 patients with cruciate ligament injuries received arthroscopic ligament reconstruction. All patients received Color Doppler ultrasound pre- operatively,3 days and 7 days after operation respectively. We recorded the incidence of DVT with different surgical type and different time of using tourniquet. [ Result] The incidence of DVT in 282 patients was 12.06%. The incidence of DVT in isola- ted ACL reconstructed patients was 7.24% ,in ACL combined with posteromedial （posterolateral） reconstruction was 12.77% , in isolated PCL reconstruction was 17.39% ,in PCL combined with posteromedial （posterolateral） was 23.53% , in simultane- ously ACL-MCL reconstruction was 25.00%. The comparison between five groups was significant（ P 〈 0.05 ）. The incidence in patients used tourniquet less than 90 minutes was 5.56% , in patients used tourniquet from 90 minutes to 120 minutes was 12. 77% and in patients with more than 120 minutes tourniquet time was 17.35%. The comparison between different tourniquet u- sing time was also significant（P 〈 0.05 ）. [ Conclusion] The incidence of DVT in patients with arthroscopie cruciate ligament surgery cant be ignored by arthroscopie surgeon. There is a high incidence in patients with PCL and its related surgery and in patients with more than 2 hours tourniquet using time, so we should pay more attention to these surgery and take some necessary prophylaxis.