Cracowski J L, Bosson J L, Baloul F, Moirant C, Hunt M, Merloz P, Carpentier P, Franco A
Department of Vascular Medicine, CHU Grenoble, France.
Vasc Med. 1998;3(4):269-74. doi: 10.1177/1358836X9800300402.
Deep-vein thrombosis (DVT) remains the most frequent complication following hip surgery. This study was designed in order to evaluate the development of DVT after hip fracture surgery, and to determine if venous wall thickening detected before surgery predisposes patients to postoperative DVT. Systematic ultrasound examinations were performed on 100 consecutive patients undergoing hip fracture surgery on the day preceding the operation, and then postoperatively on days 2, 5 and 10. A total of 12 proximal, 28 distal deep-vein and four saphenous vein thromboses were detected. Of the DVT, 19 (43%) were detected at day 2. Five out of eight patients with venous wall thickening had a previous history of DVT. Venous wall thickening was positively correlated with proximal DVT development (62.5% versus 8% incidence in the group of patients with and without venous wall thickening respectively; p<0.001, relative risk = 7.8). This study highlights the high frequency of early major thromboembolic events following hip fracture surgery. It is considered that patients with a previous history of venous thromboembolic disease should undergo B-mode ultrasonographic examination before hip fracture surgery. Patients in whom venous wall thickening is detected should have repeated postoperative ultrasonographic examinations enabling early detection of DVT.
深静脉血栓形成（DVT）仍然是髋关节手术后最常见的并发症。本研究旨在评估髋部骨折手术后DVT的发生情况，并确定术前检测到的静脉壁增厚是否会使患者易患术后DVT。对100例连续接受髋部骨折手术的患者在手术前一天进行了系统的超声检查，然后在术后第2天、第5天和第10天进行检查。共检测到12例近端、28例远端深静脉血栓和4例大隐静脉血栓。在这些DVT中，19例（43%）在第2天被检测到。8例静脉壁增厚的患者中有5例有DVT病史。静脉壁增厚与近端DVT的发生呈正相关（有和无静脉壁增厚的患者组发生率分别为62.5%和8%；p<0.001，相对风险=7.8）。本研究突出了髋部骨折手术后早期主要血栓栓塞事件的高发生率。认为有静脉血栓栓塞疾病史的患者在髋部骨折手术前应接受B型超声检查。检测到静脉壁增厚的患者术后应重复进行超声检查，以便早期发现DVT。
