| Objective: Intramuscular venous thrombosis is common in the calf muscle veins.The research found that the main reason is the limb muscle of leg venous valves in a relatively small number,velocity flow is relatively slow,the veins around without deep fascia and hard tissue protection.At the same time,the venous vessels of the leg are relatively easy to expand and are interwoven into venous net work and venous plexus.Anatomical and hemodynamic studies showed that the intramuscular venous plexus was mainly composed of the gastrocnemius vein plexus and the soleus vein plexus,and the blood flow velocity was relatively slow.To sum up,calf intramuscular venous plexus became the focus of lower extremity deep vein thrombosis.Further study showed that venous thrombosis of soleus muscle was common.The causes of calf intermuscular vein thrombosis are very diverse.It is reported that the formation and progress of calf intermuscular vein thrombosis are mainly caused by lower limb trauma,postoperative lower limb immobilization,blood viscosity,hemodynamic changes,abnormal coagulation function and other factors.Reported that calf muscular venous thrombosis without formal treatment and treatment,about 20% patients with calf muscular venous thrombosis to proximal vein trunk expansion to constitute the entire limb venous thrombosis disease,serious when still can cause thrombosis and other serious complications,even life-threatening pulmonary embolism.At the same time,the domestic and foreign scholars found that the formation of a relatively small range of calf muscular venous thrombosis thrombosis,the venous reflux effect is small,may trigger severe inflammatory reaction diffusion to a lesser extent.Therefore,the clinical symptoms of calf vein thrombosis are not obvious,which are often ignored by clinical department of orthopedics doctors.However,in recent years,the concept of anticoagulationtherapy for lower extremity venous thrombosis has been generally improved in orthopedics.Color doppler ultrasound screening of lower extremity venous thrombosis has become a common preoperative behavior in orthopedics.If the the myenteric vein thrombosis is found,surgical treatment in different diseases such as lumbar spinal stenosis of lumbar posterior surgery,knee arthroplasty,hip arthroplasty,femoral intertrochanteric fracture PFNA limited internal fixation surgery.These operations are through strict anticoagulation cycle after surgery or treatment,can improve the inspection and preoperative surgery after treatment? This issue is also a controversial issue between anesthesiologists and physicians.At the same time,the effect of different anticoagulant methods on the treatment of simple intramuscular venous thrombosis is controversial.The purpose of this study was to investigate the therapeutic characteristics and clinical significance of different anticoagulant methods in the treatment of simple intramuscular venous thrombosis.In this study,we try to find out whether the patients with intramuscular venous thrombosis can be operated directly without anticoagulant therapy,and find the scientific basis and guide the clinical work.Methods: From July 2015 to July 2017,the clinical research was performed at the Third Hospital of Hebei Medical University,Cangzhou Central Hospital and Hengshui Halison International Peace Hospital.This clinical study fully meets the requirements of medical ethics.99 cases of lumbar spinal stenosis were detected by color doppler ultrasound before operation,including 42 males and 57 females,aged from 52 to 68 years,with an average age of 60.5 years.Patients were randomly divided into two groups:treatment group and control group according to the order of admission.The patients in the treatment group were injected with low molecular weight heparin calcium 100iu/kg abdominal wall subcutaneous injection,once a day for two weeks after the calf muscle vein thrombosis was detected by color Doppler ultrasound.Patients in the control group did not use any anticoagulant drugs during the preoperative preparation.All patients were treated with posterior pedicle screw fixation,reduction and interbody fusion.Ditto,preoperative color Doppler ultrasound screening of calf intramuscular venous thrombosis in 109 patients with knee osteoarthritis,including 47 males and 62 females,aged 59 to 71 years,with an average age of 62.5 years.They were randomly divided into treatment group and control group.All patients underwent total knee arthroplasty.95 cases of femoral head necrosis of calf muscular venous thrombosis were detected by color doppler ultrasound before surgery,including 62 males and 33 females,aged from 52 to 71 years,with an average age of 61.4 years.They were randomly divided into treatment group and control group.All patients underwent total hip arthroplasty.Preoperative color Doppler ultrasound screening revealed 105 cases of femoral intertrochanteric fracture in patients with simple intramuscular venous thrombosis,including 62 males and 43 females,aged from 62 to 82 years,with an average age of 71.4 years.The patients were randomly divided into treatment group and control group.All patients underwent PFNA limited open reduction and internal fixation.All patients received the same prophylactic anticoagulant therapy postoperatively.All patients underwent color doppler ultrasonography at one month,three months and six months after operation.These were recorded in each group,the basic situation of patients with intraoperative bleeding volume,postoperative drainage,deep vein thrombosis risk grading,clinical treatment,total treatment costs,hospital bed days,wound healing time,postoperative complications like thrombosis(including deep vein thrombosis,limb artery increased embolism,fatal pulmonary embolism and death)were compared to assess,and the data were analyzed using statistical methods.Results: All patients were followed up for 6~12 months,average of 10 months.There was no significant difference in gender,age and wound healing time between the treatment group and the control group.The treatment group and control group had significant differences in the cost of total treatment and the length of hospital stay,and the cost of total treatment and the length of hospital stay in the treatment group were significantly higher than those in the control group.Compared with the control group,there was no significantdifference in the classification of deep vein thrombosis risk and the occurrence of thrombosis complications in the lumbar surgery group.Compared with the control group,the incidence of DVT and the occurrence of thrombotic complications after total knee arthroplasty and total hip arthroplasty in the treatment group were statistically significant,the treatment group was better than the control group.In PFNA limited internal fixation surgical treatment group,postoperative deep venous thrombosis risk classification,and the thrombosis complications was statistically significant.Conclusion: In this study,it is not necessary to change the operation time for anti-coagulation in the pre-operative period of intermuscular venous thrombosis in the perioperative period.At the same time,the patient should be given regular anticoagulant and rechecked regularly after operation,combinated of personalized therapy. |
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