Clinical Observation Of Anticoagulation Therapy For Venous Thrombosis Of Lower Limbs After Knee Arthroscopy

Objective As a kind of minimally invasive surgery,knee arthroscopy has been accepted by many patients and surgeons.The risk of lower extremity deep venous thrombosis(DVT)is far less than that of traditional major surgery but there are still reports of complications and even fatal pulmonary embolism.However,excessive anticoagulation treatment can increase the risk of massive bleeding and unnecessary medical resources consumption,therefore,whether anticoagulation therapy is needed after knee arthroscopy is not clear at home and abroad at present.Through comparing the incidence of DVT between anticoagulation therapy and non-anticoagulation therapy after knee arthroscopy,the clinical effect of anticoagulation therapy on DVT formation after knee arthroscopy should be confirmed,so as to explore its necessity and safety.Method The subjects,selected from September 2017 to January 2019 y were randomly divided into treatment group and control group,including arthroscopic exploration and clearance,anterior and posterior cruciate ligament reconstruction,meniscus repair or removal,popliteal fossa cyst excision and gender limitation,according to inclusion and exclusion criteria.The treatment group was given nadroparin calcium injection 3075IU 24 hours after operation once a day,the total course of treatment is 7 days.The control group does not receive any anticoagulant drugs.Routine guidance is given to the two groups of patients for functional exercises.According to the needs of the disease,patients who can carry out weight-bearing exercises immediately after operation can walk down early.Those who can not do early weight-bearing exercises,such as ligament reconstruction,will perform ankle pump exercises of lower limbs,quadriceps femoris and straight leg elevation exercises in bed.Exercise,and give the lower extremities external pneumatic pump to prevent thrombosis treatment.During the period,if there are suspected thrombosis,such as lower extremity pain,swelling,weakness and other clinical manifestations,the lower extremity color Doppler ultrasonography should be performed immediately to make a definite diagnosis.If no symptoms were found,color Doppler ultrasonography of lower extremity veins was performed on the 7th day after operation,and plasma D-dimer concentration was measured on the 3rd day and the 7th day after operation.Telephone follow-up should be conducted 1 month and 3 months after the operation.Those with dubious symptoms should come to the hospital in time for the diagnosis of lower extremity vein color Doppler ultrasonography.The incidence of deep venous thrombosis in lower extremities was observed and the differences between the two groups were compared.Result A total of 67 patients were enrolled in the study,including 31 males and 36 females,aged 35-72,with an average age of 58 years.The operation time was 0.5-3 hours.19 patients underwent arthroscopic debridement,36 meniscus repair or resection,2 patients underwent free body removal,7 patients underwent anterior and posterior cruciate ligament reconstruction,3 patients underwent popliteal cyst resection,61 patients underwent combined block anesthesia and 6 patients underwent general anesthesia.There were 16 cases of lower extremity venous thrombosis after operation,all of which were intermuscular venous thrombosis.Six patients in the treatment group and one patient had clinical symptoms.The symptoms were swelling,pain and weakness of the affected limbs.After one month of anticoagulation treatment,the incidence of thrombosis was 17.6%,95%confidence interval(4.1%,31.1%)and 10 patients in the control group,the incidence of thrombosis was 30.3%,95%confidence interval(13.8%,46.9%).There was no statistical difference.The plasma D-dimer concentration in anticoagulant group was 0.6±0.46 mg/L,2.79±1.06 mg/L and 1.77±0.7 mg/L before,3 days after and 7 days after operation,respectively.The plasma D-D concentration in control group was 0.5±0.48 mg/L,3.59±1.29 mg/L and 2.3±0.88 mg/L before,3 days after and 7 days after operation,respectively.There was no significant difference in plasma D-dimer concentration between the two groups(P>0.05).The plasma D-dimer concentration on the 3rd day after operation was higher than that on the 7th day after operation(P<0.05).The plasma D-dimer concentration in anticoagulant group was lower than that in control group on the 3rd day and 7th day after operation(P<0.05).No cases of pulmonary thromboembolism(PTE)or joint hemorrhage occurred.Conclusion The incidence of thrombosis after knee arthroscopy was 23.9%.Continuous use of nadroparin calcium 3075 IU anticoagulation therapy for 7 days after operation had no statistical difference in the prevention of DVT formation in lower extremities under the existing sample size,but it could significantly reduce the plasma D-dimer concentration,at the same time,it did not increase the risk of massive hemorrhage Therefore,in the absence of contraindications for anticoagulation therapy,it can be considered that drug anticoagulation therapy can prevent thrombosis after knee arthroscopy.