膝关节置换术后下肢深静脉血栓形成的治疗与康复

Treatment and rehabilitation of lower extremity deep venous thrombosis after knee arthroplasty

目的：探讨膝关节置换术后下肢深静脉血栓形成的早期治疗和关节康复训练的临床效果。方法回顾性分析2012年6月至2014年10月膝关节置换术后合并深静脉血栓形成病例16例的临床资料，术前常规彩超检查双下肢未见血栓，术后第2~5天彩超检查发现深静脉血栓形成，给予患肢抬高制动，尿激酶溶栓治疗，抗凝药物预防继发血栓形成，10 d 后再次复查血管彩超，同时给予肢体康复锻炼，切口术后2周拆线，华法林2.5~5 mg/ d 持续服用半年，定期监测凝血功能及肝肾功能。结果16例患者无一例出现血栓脱落导致肺栓塞死亡，全部患者中5例患者10 d 后复查彩超血栓消失，11例患者复查彩超血栓再通，15例患者半年后复查未见明显肢体肿胀，1例患者出现血栓形成综合征，肢体下垂时肿胀，抬高消退，穿弹力袜改善良好，全部患者膝关节恢复良好，活动度未受明显影响。结论早期干预治疗和积极有效的康复锻炼是治疗膝关节置换术后下肢深静脉血栓形成的有效方法，对关节置换术后的康复至关重要，可以有效改善关节功能，达到理想的预期手术效果。

Objective To investigate the clinical effects of early treatment and joint rehabilitation training on deep vein thrombosis after total knee arthroplasty. Methods From June 2012 to October 2014,the clinical data of 16 patients with deep vein thrombosis after total knee arthroplasty were retrospectively analyzed. There was no thrombosis of lower extremities detected by preoperative routine color doppler. Deep vein thrombosis was found by postoperative 2nd to 5th days color doppler ultrasound. The limb was raised and urokinase was given,anticoagulants was used to prevent the thrombosis. Vascular ultrasound was re-viewed 10 days later,and rehabilitation training was given. The stitches were taken out after two weeks of incision,Warfarin was taken continuely for 6 months,2. 5 to 5 mg/ day,and coagulation function and hepatic and renal function was monitored. Results No cases appeared pulmonary embolism and death caused by fall off of thrombosis. Five cases were found thrombosis disappeared after 10 days,11 cases were still found thrombosis but the blood flow reperfusion. There was no significant swelling of the limbs in 15 patients after six months. One case appeared thrombotic syndrome. All patients recovered well with good knee function. Conclusion The early intervention and positive and effective rehabilitation exercise is an effective treatment for deep vein thrombosis after knee replacement surgery,which can effectively improve the knee function,and obtain ideal operation effect.