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全关节置换术中下肢的静脉血流动力学改变

Venous hemodynamic alterations in lower limbs undergoing total joint arthroplasty.

作者信息

Sasaki Kousuke, Miura Hiromasa, Takasugi Shinichiro, Jingushi Seiya, Suenaga Eiji, Iwamoto Yukihide

机构信息

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.

出版信息

Am J Orthop (Belle Mead NJ). 2009 Aug;38(8):E137-40.

Abstract

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.

摘要

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。

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