不同术式膝关节镜下交叉韧带重建术后下肢深静脉血栓的发生及预防

The occurrence and prevention of deep venous thrombosis of lower extremity after arthroscopic reconstruction of cruciate ligament under knee arthroscopy

目的:探讨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情况及预防措施。方法:选取接受韧带重建手术的60例膝关节交叉韧带损伤患者,其中前交叉韧带(ACL)重建手术34例(ACL组),后交叉韧带(PCL)重建术8例(PCL组),ACL合并内(外)侧结构损伤重建术10例(ACL+MCL/LCL组),PCL合并内(外)侧结构损伤重建术5例(PCL+MCL/LCL组),ACL、PCL同时手术3例(ACL/PCL组)。分别于术后第3天、术后第7天进行超声检查,统计不同术式及止血带不同使用时间患者术后下肢深静脉血栓的发生率。结果:本组共60例患者,其中8例(13.3%)出现下肢静脉血栓。不同手术方式术后DVT发生率存在统计学差异(P<0.05),其中PCL组、PCL+MCL/LCL组、ACL+PCL组发生DVT率显著高于ACL组(P<0.05),PCL+MCL/LCL组、ACL+PCL组发生DVT率显著高于ACL+MCL/LCL组(P<0.05);止血带使用时间<90min组术后DVT发生率较>120min组显著要低(P<0.05)。结论:关节镜下交叉韧带重建术后DVT总体发生率较高,术中长时间使用止血带、后交叉韧带、多条韧带重建是DVT发生的高危因素,因此对止血带使用时间长及易栓手术给予足够的重视,采用必要的抗凝措施进行预防。

Objective:To investigate the incidence and prevention of deep venous thrombosis of lower extremity after arthroscopic reconstruction of cruciate ligament under knee arthroscopy.Methods:60 patients with cruciate ligament injury undergoing ligament reconstruction were selected and examined by ultrasonography after 3 days and 7 days after operation respectively.The incidence of deep vein thrombosis after operation was compared.Results:There were 60 patients in this group,of which 8 cases(13.3%)had venous thrombosis of the lower limbs.There was a significant difference in the incidence of DVT after operation(P<0.05),among them,the incidence of DVT in PCL group,PCL+MCL/LCL group and ACL+PCL group was significantly higher than that in group ACL(P<0.05),and the rate of DVT in PCL+MCL/LCL group and ACL+PCL group was significantly higher than that in group ACL+MCL/LCL(P<0.05).The incidence of DVT in group<90 min after the use of tourniquet was significantly lower than that in group>120min(P<0.05).Conclusion:Arthroscopic cruciate ligament reconstruction after the overall incidence of DVT is high,with long time use of tourniquet,posterior cruciate ligament,a ligament reconstruction is the high risk factors of DVT,thus giving enough attention to the use of tourniquet duration and thrombophilia surgery,anticoagulation measures necessary for the prevention.