Maezawa Katsuhiko, Nozawa Masahiko, Aritomi Kentaro, Kubota Mitsuaki, Shitoto Katsuo, Kurosawa Hisashi
Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Arch Orthop Trauma Surg. 2008 Jan;128(1):37-40. doi: 10.1007/s00402-007-0361-4. Epub 2007 May 24.
Marked activation of thrombosis is common in patients undergoing total hip arthroplasty, especially during reaming of the femur and after insertion of the femoral prosthesis. This suggests that management designed to minimize deep vein thrombosis and fatal pulmonary embolism after total hip arthroplasty should be focused on the period during insertion of the femoral component. In some previous studies, a low dose of heparin administered intraoperatively was shown to suppress the formation of fibrin.
The present study was performed to evaluate the influence of intraoperative heparin administration on the D-dimer level and on the prevention of pulmonary embolism after total hip arthroplasty.
MATERIAL/METHODS: A total of 22 and 26 consecutive patients respectively underwent total hip arthroplasty with and without intraoperative administration of unfractionated heparin. Postoperatively, all patients wore knee-high elastic stockings and were fitted with calf-to-thigh intermittent pneumatic compression devices. Active ankle flexion and extension exercises were commenced as soon as motor function recovered. None of the 48 patients received prophylactic anticoagulants postoperatively.
There was a significant difference of the mean D-dimer level on the 1st day between the patients with and without intraoperative administration of heparin (8.9 +/- 6.6 vs. 15.7 +/- 12.7, P < 0.05). Although there were no patients with symptomatic deep venous thrombosis and pulmonary embolism, asymptomatic pulmonary embolism was detected by pulmonary perfusion scintigraphy in three patients who did not receive intraoperative heparin. The operative blood loss and postoperative drainage were similar in both groups and no bleeding complications were observed. In conclusion, we recommend a safe and inexpensive regimen comprising 1,000 U of intravenous unfractionated heparin intraoperatively, postoperative pneumatic compression, and early active mobilization for prevention of thoromboembolic complications after total hip arthroplasty.
在接受全髋关节置换术的患者中，血栓形成的明显激活很常见，尤其是在股骨扩髓期间和股骨假体植入后。这表明，旨在尽量减少全髋关节置换术后深静脉血栓形成和致命性肺栓塞的管理措施应集中在股骨部件植入期间。在一些先前的研究中，术中给予低剂量肝素可抑制纤维蛋白的形成。
本研究旨在评估术中给予肝素对全髋关节置换术后D-二聚体水平及预防肺栓塞的影响。
材料/方法：分别有22例和26例连续患者接受了术中给予或未给予普通肝素的全髋关节置换术。术后，所有患者均穿着膝高弹力袜，并配备了小腿至大腿的间歇性气动压迫装置。一旦运动功能恢复，即开始主动踝关节屈伸练习。48例患者术后均未接受预防性抗凝治疗。
术中给予肝素和未给予肝素的患者在术后第1天的平均D-二聚体水平存在显著差异（8.9±6.6 vs. 15.7±12.7，P<0.05）。虽然没有患者出现症状性深静脉血栓形成和肺栓塞，但在3例未接受术中肝素治疗的患者中，通过肺灌注闪烁显像检测到无症状性肺栓塞。两组的手术失血量和术后引流量相似，未观察到出血并发症。总之，我们推荐一种安全且廉价的方案，包括术中静脉注射1000 U普通肝素、术后气动压迫以及早期主动活动，以预防全髋关节置换术后的血栓栓塞并发症。
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