Lombardi Adolph V, Berend Keith R, Tucker Tawnya L
Joint Implant Surgeons, Inc, New Albany, Ohio, USA.
Orthopedics. 2007 May;30(5 Suppl):46-8.
Deep venous thrombosis (DVT) and pulmonary embolism (PE) are significant concerns following lower extremity arthroplasty. Many prevention protocols exist. This study investigates the rate of venous thromboembolic disease (DVT and PE) in 423 patients undergoing consecutive unicompartmental knee arthroplasties by two surgeons (A.V.L., K.R.B.) using a multimodal prophylactic strategy. Risk stratification by the medical consulting team determined appropriate anticoagulation level. Eighty-two percent (knees) were managed with an aspirin-based program, 8% with 2 weeks of low molecular weight heparin followed by aspirin, and 8% with warfarin. No patient experienced symptomatic DVT or PE. Radiographic investigations revealed no asymptomatic venous thromboembolic disease. A risk stratification and multimodal venous thromboembolic disease prevention program based on the efficacy and safety of aspirin may prove to be the safest, most effective method in patients undergoing unicompartmental knee arthroplasty. The minimally invasive nature and rapid recovery associated with unicompartmental knee arthroplasty may support approaching the procedure more as an arthroscopy than an arthroplasty in terms of venous thromboembolic disease prevention.
下肢关节置换术后，深静脉血栓形成（DVT）和肺栓塞（PE）是重要问题。现有多种预防方案。本研究调查了423例接受连续单髁膝关节置换术的患者中静脉血栓栓塞性疾病（DVT和PE）的发生率，手术由两位外科医生（A.V.L.，K.R.B.）进行，采用多模式预防策略。医学咨询团队进行风险分层，确定适当的抗凝水平。82%（膝关节）采用以阿司匹林为主的方案治疗，8%采用2周低分子量肝素治疗后再用阿司匹林，8%采用华法林治疗。无患者发生有症状的DVT或PE。影像学检查未发现无症状的静脉血栓栓塞性疾病。基于阿司匹林的疗效和安全性的风险分层及多模式静脉血栓栓塞性疾病预防方案可能是单髁膝关节置换术患者最安全、最有效的方法。单髁膝关节置换术的微创性和快速恢复特性，在预防静脉血栓栓塞性疾病方面，可能支持将该手术更多地视为关节镜手术而非关节置换术。
