全膝关节置换后短期血栓预测:D-D二聚体与纤维蛋白降解产物的动态监测

Thrombosis prediction within short time after total knee arthroplasty: dynamic monitoring of D-Dimer and fibrin degradation products

背景:对于人工膝关节置换后的下肢深静脉血栓形成,近年来逐渐得到重视,然而在临床中究竟如何早期发现下肢深静脉血栓。是否每个置换后患者都需常规行下肢血管B超或者其他有创检查,成为一个关注点。目的:探讨D-D二聚体及纤维蛋白降解产物在预测全膝关节置换后下肢深静脉血栓中的意义。方法:纳入2012年12月至2014年2月在解放军第306医院骨科行全膝关节置换的患者56例,动态监测置换前及置换后1,3,5,7,10 d的D-D二聚体及纤维蛋白降解产物,置换后10 d行双下肢静脉彩超,根据B超结果分为血栓组与非血栓组。对比两组患者间D-D二聚体及纤维蛋白降解产物的水平。结果与结论:56例患者中共有13例全膝关节置换后复查B超时发现血栓。D-D二聚体指标及纤维蛋白降解产物在置换后1周内血栓组与非血栓组差异均无显著性意义(P>0.05),置换后10 d时,两组间差异有显著性意义(P<0.01)。提示动态监测膝关节置换患者D-D二聚体及纤维蛋白降解产物至置换后10 d,有助于早期发现血栓。

BACKGROUND： Deep vein thrombosis after total knee arthroplasty has attracted increasing attention in recent years, but how to detect deep vein thrombosis in the early time in clinical practice remains unclear. Whether it is necessary to perform type-B ultrasonic or other invasive examination in lower limbs has become a hot issue. OBJECTIVE： To explore the significance of D-Dimer and fibrin degradation products in the prediction of deep vein thrombosis after total knee arthroplasty. METHODS： 56 patients received total knee arthroplasty were collected from Department of Orthopedics, The 306th Hospital of Chinese PLA, between December 2012 and February 2014. The D-Dimer and fibrin degradation products were dynamically monitored before operation and at 1, 3, 5, 7, 10 days post-operation. All the patients received type-B ultrasonic examination in double lower limbs at 10 days post-operation, and divided into thrombus group and non-thrombus group. The D-Dimer and fibrin degradation products in the two groups were compared. RESULTS AND CONCLUSION： Deep vein thrombosis was found in 13 cases by ultrasonic-B postoperation, D-Dimer and fibrin degradation products showed no significant difference between the two groups at 1 week after operation （P 〉 0.05）, but the difference was significant at 10 days （P 〈 0.01）. D-Dimer and fibrin degradation products index should be monitored dynamically for at least 10 days after operation, which is helpful for the early diagnosis of thrombosis.