人工膝关节置换术后小腿深静脉血栓的转归

Prognosis of calf deep-vein thrombosis after total knee arthroplasty

目的:探讨膝关节置换术后小腿深静脉血栓的治疗方法和临床转归。方法:选取2009年6月至2011年6月接受人工膝关节置换术后发生小腿深静脉血栓患者159人,分为主动活动组80人(A组)和被动活动组79人(B组),在术后1周及4周行下肢深静脉血管彩色超声检查,观察2组患者血栓的消失率和进展率,以及膝关节活动度、膝关节KSS评分、WOMAC评分的变化。结果:术后4周A组和B组的小腿血栓消失率分别是35%和33%,差异无统计学意义(P=0.91);没有血栓向近端进展,术后2组患者的膝关节活动度(111.9°±13.4°vs.110.5°±10.9°,P=0.490)、KSS临床评分(93.5±4.7 vs.93.9±5.1,P=0.621)、KSS功能评分(83.4±15.1 vs.82.9±14.5,P=0.513)及WOMAC评分(90.9±5.7 vs.90.3±6.1,P=0.535)差异无统计学意义。结论:膝关节置换术后发生的小腿深静脉血栓随着时间推移有自动消失的趋势,并不需要进行额外的抗凝或溶栓治疗。

Objective： To explore the outcome of deep-vein thrombosis （DVT） in the calf after total knee arthroplasty. Methods： From June 2009 to June 2011, 159 patients with DVT in the calf after total knee arthroplasty （TKA） were divided into two groups. Group A （active mobilization）included 80 pa- tients and group B （passive mobilization） 79 patients. These patients were checked with ultrasonography 1 week and 4 weeks postoperation. The changes of DVT in the calf, ROM, KSS score and WOMAC score were observed. Results： The disappearance rates of the calf DVT in groups A and B were 35% and 33% 4 weeks postoperation. There was similar DVT disappearance rate in the two groups （P =0.91 ）. No pa- tient developed proximal propagation. There was no difference of the ROM （111.9° ± 13.4° vs. 110.5° ± 10.9°, P=0.490）, KSS knee score （ 93.5 ±4.7 vs. 93.9 ±5.1, P =0.621）, KSS function score （83.4±15.1 vs. 82.9±14.5, P=0.513） and WOMAC score （90.9 ±5.7 vs. 90.3 ±6.1, P= 0.535） in groups A and B. Conclusion： A DVT in the calf after TKA can resorb spontaneously with time. The treatment of a DVT in the calf does not need additional anticoagulation.