| Part1Investigate the incidence of clinical symtomatic VTES after THA at our hospital and analysis the main factors of VTE after THA at our hospital1:Investigate the incidence of clinical symtomatic VTES after THA at our hospital Method:we retrospectively the298patients which performed THA at our hospital between jan,2007to Jan2010.We investigate the incidence of clinical symtomatic VTES after THA. We compare the incidence of clinical symtomatic VTES after THA between HSS and Our hospital.2:Analysis the main factors of VTE after THA at our hospital using Multivariate statistical analysis of Discrimint analysis and Logistic regression analysis.Part2Multimodal Prophylaxis for Venous Thromboembolism Disease after Total Hip Arthroplasty at HSSMethodWe observed993consecutive patients who had THAs performed between Jan,2006and August,2010.We excluded patients with thrombocytopenia or preexising bleeding diathesis and patients for whom epidural analgesia was not possible.The median age of the patients was64years (range,20-96years);52.8%were women (529of933));47.2%were men(473Of933);and91.9%had osteoarthritis(913of933),2.3%had osteonerrosis(23of933),2.1%had dysplasia(21of933),1.9%had rheumatoid arthritis (19of933),and1.7%had other diagnoses(17of933). Preexiting comrbidities were identified and patients were classified according to the ASA classification.Surgery was performed by one of two surgeons (EAS, TPS). The mean operative time was83minutes.The surgeries were performed under hypotensive epidural anestheisa (mean arterial pressure between45-55mm Hg) through a posterolateral approach,minimizing the duration of femoral vein obstruction and reducing the load of intramedullary content to the venous system by repeated pulsatile lavage and aspiration of the femoral canal.The lower extremity was in the neutral position while working on the acetabulum and flexed and internally rotated while working on the femur. Whenever possible, the lower extremity was extended to a neutral position to restore femoral venous flow.Patients received one bolus of unfractionated intravenous heparin (10-15U/kg),1to2minutes before femoral canal preparation.Postoeratively,all patients recived intermittent pneumatic compression as soon as the patient arrived to the recovery room,knee-high elastic stockings.immediate active ankle flexion and extension exercises, and early ambulation beginning on postoperative Day1.In addition,71.1%(707of933) of patients received an antiplatelet agent (325mg aspirin twice a day) and28.9%(286of933) received warfarin because of intolerance to aspirin, previous cardiac comorbidities,or a high clinical risk for thromboembolic disease.The pharmacologic prophylaxis started the night of surgery and continued for4to6weeks. Warfarin was monitored to maintain prothrombin time levels at1.8to2times control.If there was clinical suspicion of DVT, the patients were evaluated with Doppler ultrasound and with magnetic resonance venography.DVT were classified as proximal (pelvic, femoral, popliteal) or distal (calf). Symptomatic PEs were evaluated with ventilation perfusion scans or Spiral CT. Patients had spiral comtuted tomography.All patients with a positive DVT were treated with warfarin (patients with distal DVTs for6weeks;Patients with proximal DVTs for3months).Patients with clinically symptomatic Pes,confirmed by ventilation and perfusion scans were treated with heparin followed by warfarin for3-to6months。All patients followed up at least3months postoperatively.No patient was lost to followup.The comparaed groups were divided into two two goups.The first one is the patients were performed THA in the second hospital afficiated with kunming medical university. We observed298consecutive patients who had THAs performed between Jan,2007and May,2011..The median age of the patients was68years (range,28-93years);52.4%were women;47.6%were men;and36.9%were femoral neck fracture;28.4%were OA,26.5%had osteonerrosis;3.5%had dysplasia(21of933),5%had rheumatoid arthritis (19of933),and1.7%had other diagnoses(17of933)2:Multivariate statistical analysis of Discrimint analysis and Logistic regression analysis for the main factors of VTE after THAMethod:We retrospectively993consecutive patients who had THAs performed between Jan,2006and August,2010.We excluded patients with thrombocytopenia or preexising bleeding diathesis and patients for whom epidural analgesia was not possible.The median age of the patients was64years (range,20-96years);52.8%were women (529of933));47.2%were men(473Of933);and91.9%had osteoarthritis(913of933),2.3%had osteonerrosis(23of933),2.1%had dysplasia(21of933),1.9%had rheumatoid arthritis (19of933),and1.7%had other diagnoses(17of933). Preexiting comrbidities were identified and patients were classified according to the ASA classification.We analyze the main factors associated with VTE after THA using Multivariate statistical analysis of Discrimint analysis and Logistic regression analysis.Part3Multimodal Prophylaxis for Venous Thromboembolism Disease after Total Hip Arthroplasty at our hospitalMethod:We randomly divided the patients who performed THA into two groups.Group one choose mutimodal prophylaxis for VTE after THA.Group two choose standard prophylaxis for VTE after THA.Part4Changes of the expressions of plasma inflammatory cytokine in patients with deep vein thrombosis after total hip replacementTo evaluate the changes of the expressions of tumor necrosis factor alpha (TNF-α), C-Creative Protein, macrophageinn-matoryprotein-la in patients with deep vein thrombosis (DVT) after total hip replacement (THR),30inpatients treated with THR were selected between October2010and August2012. All the patients accepted ultrasound imaging examination and various laboratory serum sampling collections voluntarily. Blood flow of deepvein in lower limbs was examined with color Doppler ultrasound in all the patients after THR. The concentrations of TNF-α,C-Creative Protein, macrophageinn-matoryprotein-la were determined with enzyme linked immunosorbent assay.ResultsPart11:The incidence of clinical symoptomatic VTE is6.7%(18Of298) The incidence of Deep vein thrombosis was5.3%. with prophylaxis after hip arthroplasty.2:2:The factors including more thanHTN,,the history of DVT and PE,,duration of surgery were associated with VTEs after THA.Part21:The multimodal prophylaxis protocol at HSS was associated with a low requirement of homologous blood transfusion.Comp lete information on blood loss was avaible for patients.It showed a mean preoperative hematocrit of38.6%.The mean hematocrit decrease at discharge was32%.21.1%Of patients required no blood transfusion.69.4%of the remaining patients received autologous blood,4.4%received homologous blood, and4.9%received both.The mean number of autologous units transfusion was1.09and the amount of homologous blood transfused was1.25units per patient. Among the patients receiving homologous blood,34patients received one unit,8patients received two units, and2patients received three units.The incidence of clinical symoptomatic VTE is0.03%(13Of933) The incidence of Deep vein thrombosis was0.8%,which diagnosed with ultrasound in6patients and magnetic resonance venography in2patients.There were8proximal and distal clots.4Of the proximal clots,0were iliac,2were femoral,2were popliteal and femoral, and0was femoral and iliac. Among the DVTs dianosed in this study,6were ipsilateral,2were contralateral, and0were bilateral.5Of patients had a symptomatic PE. These were documented by ventilation and perfusion scans in4patients and bi spiral computed tomography in1patient. There was no fatal Pes.8Of these patients were diagnosed during the first postoperative week (postoperative Day 1to postoperative Day7);5VTEs developed during the second postoperative week.Among13patients who had VTEs develop,10had clinical predisposing factors.The prevalence of synptpmatic VTEs in patients who received aspirin was0.9%(7of707) and Coumadin prophylaxis was2%(6Of286).2:The factors including HTN,the history of DVT and PE,,duration of surgery and cheo and radio tumor with were associated with VTEs after THA.Part3The incidence of clinical symoptomatic VTE between Multi group and control group is no signicant diffrience (p=0.207).There is no significant difference of bood loss and duration of surgery between the multi group and control group (P>0.05)).There is significant difference of expence of anticoagulants between two groups (P<0.001).Part4The expressionsof inflammatory cytokines of TNF-α, TNF-α,C-Creative Protein, macrophageinn-matoryprotein-la postoperatively in the thrombus group were obviously higher than those in the control group (P<0.01-0.05). The expressions of related plasma inflammatory cytokines areenhanced in patients with DVT early after THR.ConclusionThe prevalence of venous thrombolism (DVT AND PE) after Total Hip Arthroplasty is very low using Multimodal prophylaxis. The amount of blood loss in the surgery and duration time of the surgery is also low.Less patients who need transfusin and the amount of transfusion is very low.We implemented mutlmodal prophylaxis for VTEafter THA according to the HSS protoclo and the factors which analyzed at our hospital.We compared two groups at pur hospital.The result shows The incidence of clinical symoptomatic VTE between Multi group and control group is no signicant diffrience (p=0.207) and there is no significant difference of bood loss and duration of surgery between the multi group and control group (P>0.05). There is significant difference of expence of anticoagulants between two groups (P<0.001).So we need more cases or multi center to evaluate the multi protoclo in advance. |
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