White Richard H, Henderson Mark C
Division of General Medicine, University of California, Sacramento, California 95817, USA.
Curr Opin Pulm Med. 2002 Sep;8(5):365-71. doi: 10.1097/00063198-200209000-00004.
Elective total hip and total knee arthroplasty surgeries are associated with an extraordinarily high incidence of asymptomatic venous thromboembolism (VTE). Symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) is diagnosed in only 2%-4% of these patients. A number of studies have defined the incidence and time course of symptomatic thromboembolism after these procedures. Knee arthroplasty is associated with a very high incidence of asymptomatic calf vein thrombosis, with almost all symptomatic VTE events diagnosed in the first 21 days after surgery. Hip arthroplasty, however, is associated with a higher incidence of asymptomatic proximal thrombi and a modestly higher incidence of symptomatic VTE events, many diagnosed up to 6 or 8 weeks after hospital discharge. Extended medical thromboprophylaxis has been shown to reduce the incidence of symptomatic and asymptomatic VTE among hip arthroplasty patients but not among knee arthroplasty patients. Risk factors for VTE after knee arthroplasty are not well defined. Important risk factors that have been shown to be associated with the development of VTE after hip surgery include (1) a history of prior VTE, (2) obesity (body mass index > 25), (3) delay in ambulation after surgery, and (4) female sex. Factors associated with lower risk include (1) Asian/Pacific Islander ethnicity, (2) use of pneumatic compression among non-obese patients after surgery, and (3) extended thromboprophylaxis after hospital discharge.
择期全髋关节置换术和全膝关节置换术与无症状静脉血栓栓塞症（VTE）的极高发病率相关。这些患者中仅有2%-4%被诊断为有症状的深静脉血栓形成（DVT）或肺栓塞（PE）。多项研究已经明确了这些手术后有症状血栓栓塞的发病率和时间进程。膝关节置换术与无症状小腿静脉血栓形成的高发病率相关，几乎所有有症状的VTE事件都在术后21天内被诊断出来。然而，髋关节置换术与无症状近端血栓的较高发病率以及有症状VTE事件的略高发病率相关，许多病例在出院后6至8周才被诊断出来。延长药物性血栓预防已被证明可降低髋关节置换术患者中有症状和无症状VTE的发病率，但对膝关节置换术患者无效。膝关节置换术后VTE的危险因素尚不明确。已被证明与髋关节手术后VTE发生相关的重要危险因素包括：（1）既往VTE病史；（2）肥胖（体重指数>25）；（3）术后活动延迟；（4）女性。与较低风险相关的因素包括：（1）亚洲/太平洋岛民种族；（2）非肥胖患者术后使用气动压迫；（3）出院后延长血栓预防。
