LaBan Myron M, Whitmore Craig E, Taylor Ronald S
Department of Physical Medicine & Rehabilitation, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Am J Phys Med Rehabil. 2003 May;82(5):418-20. doi: 10.1097/01.PHM.0000064741.97586.E4.
After joint arthroplasty, the risk of deep vein thrombosis and pulmonary embolism increases exponentially. Inadequate anticoagulation prophylaxis may not sufficiently reduce the risk of thrombosis, whereas excessive anticoagulation therapy may predispose the patient to a bleed. Bilateral adrenal hemorrhage is a relatively rare but potentially catastrophic life-threatening event. An 82-yr-old woman is described who was rehospitalized from a subacute rehabilitation facility complaining of epigastric pain radiating into her flank. Eight days previously, she had undergone an uncomplicated bilateral total knee arthroplasty and was subsequently administered subcutaneous heparin and warfarin. An abdominal computed tomographic scan subsequently demonstrated bilateral small adrenal hemorrhages. Acute adrenal insufficiency (Addison's disease) caused by hemorrhage within the adrenal cortices, although still uncommon, can be expected to increase as anticoagulation prophylaxis after joint arthroplasty becomes routine.
关节置换术后，深静脉血栓形成和肺栓塞的风险呈指数级增加。抗凝预防措施不足可能无法充分降低血栓形成的风险，而过度的抗凝治疗可能使患者易发生出血。双侧肾上腺出血是一种相对罕见但可能危及生命的灾难性事件。本文描述了一名82岁女性，她从亚急性康复机构再次入院，主诉上腹部疼痛放射至胁腹。8天前，她接受了一次无并发症的双侧全膝关节置换术，随后接受了皮下肝素和华法林治疗。腹部计算机断层扫描随后显示双侧肾上腺小出血。肾上腺皮质内出血引起的急性肾上腺功能不全（艾迪生病）虽然仍然不常见，但随着关节置换术后抗凝预防措施成为常规操作，预计其发生率会增加。
