Salvati Eduardo A, Sharrock Nigel E, Westrich Geoffrey, Potter Hollis G, Valle Alejandro González Della, Sculco Thomas P
Department of Orthopaedics, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY 10021, USA.
Clin Orthop Relat Res. 2007 Jun;459:246-54. doi: 10.1097/BLO.0b013e31805b7681.
Total hip arthroplasty is an operation with a high risk for venous thromboembolism. Three decades of research conducted at the Hospital for Special Surgery identified the exact timing of the thrombogenic stimulus during surgery, defined the role of magnetic resonance venography, and established the role of certain genetic and acquired predispositions. Based on these studies, we implemented a multimodal prophylaxis consisting of a series of safe preventive measures applied before, during, and immediately after surgery to reduce the risk of venous thromboembolism. If these safe preventive measures are strictly observed, postoperative pharmacologic prophylaxis does not need to be aggressive in the patient without predisposing factors who mobilizes promptly, thus diminishing the risk of bleeding associated with the use of anticoagulants and the overall cost of care. Our clinical experience with more than 5000 total hip arthroplasties performed during the last decade and closely followed prospectively for a minimum of 3 months clearly shows this multimodal prophylaxis is safe and effective resulting in a very low prevalence of thromboembolism.
全髋关节置换术是一种静脉血栓栓塞风险很高的手术。特种外科医院进行的三十年研究确定了手术期间血栓形成刺激的确切时间，明确了磁共振静脉造影的作用，并确立了某些遗传和后天易患因素的作用。基于这些研究，我们实施了一种多模式预防措施，包括在手术前、手术期间和手术后立即采取的一系列安全预防措施，以降低静脉血栓栓塞的风险。如果严格遵守这些安全预防措施，对于没有易患因素且能迅速活动的患者，术后药物预防无需过于激进，从而降低与使用抗凝剂相关的出血风险和总体护理成本。我们在过去十年中进行的5000多例全髋关节置换术的临床经验，并对其进行了至少3个月的密切前瞻性随访，清楚地表明这种多模式预防措施是安全有效的，导致血栓栓塞的发生率非常低。
