彩超诊断小腿肌间静脉血栓对骨科手术诊疗的应用价值

The application value of color Doppler ultrasonography in diagnosis of venous plexus thrombosis of calf muscle for orthopedic operation treatment

目的探讨超声诊断小腿肌间静脉血栓对骨科手术及治疗的指导价值。方法应用彩色多普勒血流显像(CDFI)对500例骨科住院患者进行术前、术后常规双下肢深静脉筛查,分析患小腿肌间静脉血栓者的年龄、治疗前后2周内生化指标及超声改变情况。结果彩超检出小腿肌间静脉血栓54例,术前发生肺栓塞者2例。术前及术后制动造成血栓者32例(59.3%);术前已患有血栓者22例(40.7%);其中血压、血脂增高者32例,年龄均为50岁以上(59.3%)。抗凝、溶栓治疗后,CDFI显示病变管腔内由无血流信号逐渐变为可见部分血流信号或血流通畅;生化检测中:血浆抗凝血酶Ⅲ活性测定及凝血酶原时间指标逐渐升高,D-二聚体、纤维蛋白原及凝血酶活动度指标逐渐降低。抗凝、溶栓2周后行手术治疗者未发现有肺栓塞发生。结论彩超检查小腿肌间静脉血栓简便、易行,可持续观察,还可有效的预防其进一步延伸,对手术患者的诊疗具有临床指导价值,可最大限度的减少肺栓塞的发生。

Objective To evaluate the application value of diagnosing venous thrombosis of calf muscle by color Doppler uhrasonography in orthopedic operation treatment. Methods 500 hospitalized patients were enrolled in this study. The color Doppler flow imaging（CDFI） was performed routinely in these patients to scan the deep venous in lower extremities before and after the operation. The age, biochemical indicators and uhrasonographic characters were analyzed in the patients with calf muscle venous thrombosis before and after 2-week anticoagulation and thrombolytic treatment. Results The 54 patients were diagnosed as calf muscle venous thrombosis by color Doppler uhrasonography, in which 2 cases were complicated by pulmonary embolism before orthopedic operation. The 32 patients （ 59.3% ） with thrombosis were caused by brake before or after surgery, 22 patients（40.7% ）were diagnosed as thrombosis before surgery. Hypertension and hyperlipidemia were detected in 32 patients （59. 3% ）whose age was over 50 years. After anticoagulation and thrombolytic therapy, CDFI characters were changed gradually from no blood flow to part of the blood flow visible in lumina or fluent blood flow. As respect of biochemical indicators, plasma antithrombin 11] activity and prothrombin time index were increased, however, D-dimer, fibrinogen and thrombin activity index were decreased gradually. No pulmonary embolism was observed during orthopedic surgery after anticoagulation and thrombolytic treatment for 2 weeks. Conclusion Color Doppler ultrasonography is an useful method to diagnose calf muscle vein thrombosis, so as to prevent deep vein thrombosis effectively, which is valuable for diagnosis and treatment of surgical patients in clinic in order to minimize the incidence of pulmonary embolism.