| Object: With the development of arthrosurgery and the continuous improvement of the awareness of pulmonary embo- lism. It is important that the prevention and earlier diagnosis of DVT after knee arthroplasty. The thesis studied the clinical risk factors of postoperative deep venous thrombosis (DVT). The objective of the research is the scientific evaluation of DVT after knee arthroplasty, the promotion of the indivi- dualized preventive measures and the development of the future clinical work.Methods: A case-case control study of September 2007 to January 2009 120 cases of 137 total knee arthroplasty(TKA) was made after an analysis of the incidence of DVT, which included 49 cases of male, 71 cases of female and the average age of 64 years (56 ~ 82years). Exclusion criteria: (1) suffering from malignant tumors; (2) abnormal preoperative coagulation function; (3) with cerebrovascular diseases; (4) preoperative venous thrombosis exist; (5) there is the history of vascular surgery; (6) there is a taboo drug anticoagulant therapy; (7) severe liver, kidney, heart dysfunction; (8) have not been controlled hypertension; (9) pregnancy. Grouping methods: (1) of all cases according to (≤60, 61-70, 71-80,> 80) age groups were divided into 4 groups. (2) of all cases by a single joint replacement arthroplasty group into the left side and the right group. (3) according to body mass index (BMI) was divided into normal group (BMI≤25kg/m2) and obese group (BMI> 25kg/m2). (4) of all cases by sex into male and female groups. Replacement surgery did by the same group of physicians, according to the situation in patients with general anesthesia. Preventive anticoagulant medication methods: patients with preoperative 12 h, after 12 h and after 7 ~ 10 d by 4100 Axa ICU abdominal subcutaneous LMWH daily one time and found that patients with thrombosis instead of every 12 h administered one time. Postoperative use of elastic pressure bandage from distal lower limb surgery decreased leg bandaged.Knee passive exercise machine (CPM) and foot pump daily one times to give passive exercise was used two days after operation. All patients at the preoperative ultrasound examination, except for lower extremity DVT and other vascular diseases, were examined blood flow in deep veins and DVT formation (iliac vein, femoral vein, popliteal veins and small inter-leg vein) 3~7d after operation by ultrasound Doppler. All were checked by the same physicians. Lower extremity DVT diagnostic criteria: (1) lumen venous pressure should not closed; (2) for luminal hypoechoic or anechoic; (3) paragraph vein thrombosis is no blood flow signals within or just explore and a small amount of blood flow signal; ( 4) Pulsed Doppler revealed no blood flow or changes in the spectrum do not vary with respiration. According to color Doppler ultrasound examination records of all patients after 3~7d whether or not there was the occurrence of DVT as the only point of observation time, respectively, of 4 patients with clinical factors Detect and detailed records, including age, gender, body mass index (BMI) and the lateral joint replacement. Of four clinical factors and artificial joint replacement after the formation of the relevance of DVT were analyzed. All data with EXCEL database, the data SPSS13.0 statistical software used for analysis. Classification of single-factor analysis of variables usingχ2 test, P <0.05 for the difference had statistical signifi- cance.Results: Postoperative DVT patients had 37 people, DVT incidence of 30.8%(37/120), in which patients with asympto- matic DVT accounted for 54.1% (20/37). Not happened in 83 cases of patients with DVT, unilateral TKA were 74 cases, 9 cases of persons with bilateral TKA. The relationship between clinical risk factors and the formation of postoperative DVT: 60-70 age group, the left lower extremity joint replacement group, the obese group (BMI> 25 kg/m2) and female group of lower extremity joint replacement higher incidence of postoperative DVT, their differences with statistical significance (P <0.05). Complications: none of the patients developed symptoms of pulmonary embolism, contrast agent allergy, low molecular weight heparin allergy, transfusion reactions, inject- tion site hematoma, and complications such as skin necrosis.Conclusion: Women, obesity were the risk factors of the occurrence of DVT after total knee replacement. The formation of DVT was more happened in 50-60 years old age group. The risk of lower extremity DVT was more severe in the left of knee replacement arthroplasty than the right side. The substantial existence of asymptomatic DVT after TKA suggested that the better method is conventional color Doppler or angiography exams at both lower extremities after arthroplasty. Once the DVT has happened, timely treatment and prevention of the occurrence of fatal pulmonary embolism would be taken. |
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