Sasaki Kousuke, Miura Hiromasa, Takasugi Shinichiro, Jingushi Seiya, Suenaga Eiji, Iwamoto Yukihide
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
Am J Orthop (Belle Mead NJ). 2009 Aug;38(8):E137-40.
Using duplex ultrasonography, we measured preoperative and postoperative venous flow volume in 32 operated lower limbs without deep vein thrombosis (DVT) after total hip arthroplasty (THA, n = 17) and total knee arthroplasty (TKA, n = 15). We also calculated percentage decrease in mean venous flow volume (MVFV) from before surgery to after surgery. Patients with a history of one of several venous diseases, congestive heart failure, or morbid obesity were excluded. In both groups (THA, TKA), MVFV 3 days after surgery and MVFV 1 week after surgery were significantly lower than preoperative MVFV, but MVFV at 2 or more weeks after surgery did not differ significantly from preoperative MVFV (result 1). Incidentally, the decrease in MVFV in the lower limbs was significantly larger 3 days after TKA than 3 days after THA (result 2). As venous stasis has a central role in thrombus formation, result 1 suggests that the risk for DVT initiation is low at 2 or more weeks after THA and TKA in patients with normal preoperative venous physiologic functions. Result 2 is probably correlated with the evidence that DVT incidence is higher after TKA than after THA.
我们使用双功超声检查法,测量了32例接受全髋关节置换术(THA,n = 17)和全膝关节置换术(TKA,n = 15)且术后无深静脉血栓形成(DVT)的下肢术前和术后的静脉血流量。我们还计算了平均静脉血流量(MVFV)从术前到术后的减少百分比。排除有多种静脉疾病、充血性心力衰竭或病态肥胖病史的患者。在两组(THA组、TKA组)中,术后3天和术后1周的MVFV均显著低于术前MVFV,但术后2周或更长时间的MVFV与术前MVFV无显著差异(结果1)。顺便提一下,TKA术后3天下肢MVFV的降低幅度明显大于THA术后3天(结果2)。由于静脉淤滞在血栓形成中起核心作用,结果1表明,术前静脉生理功能正常的患者在THA和TKA术后2周或更长时间发生DVT的风险较低。结果2可能与TKA术后DVT发生率高于THA术后这一证据相关。