Khuangsirikul Saradej, Sampatchalit Sudsriluk, Foojareonyos Trakool, Chotanaphuti Thanainit
Department of Orthopaedics, Phramongkutklao Hospital, Bangkok 10400, Thailand.
J Med Assoc Thai. 2009 Dec;92 Suppl 6:S39-44.
Deep venous thrombosis (DVT) is a disease associated with high morbidity in 40-60% patients who underwent Total Knee Arthroplasty (TKA). Postthrombotic syndrome (PTS) is a common long-term complication that may develop within 6 months or more than 2 years after episode of DVT.
To examine the prevalence of PTS in patients who had history of previous DVT and non-previous DVT at least 2-year follow-up period after TKA.
Retrospective chart review was done. All patients who underwent TKA during October 2002-2005 were included. They were postoperatively assessed for PTS with Villalta score and duplex ultrasonography at > or =2 years. The confirmed diagnosis of DVT was done by contrast venography.
22 of 76 patients (56 previous DVT 20 non-previous DVT) had PTS based on the clinical assessment. The previous-DVT group had significantly higher risk to PTS (OR = 1.59; 95% CI: 1.294-1.949; p-value = 0.001). When diagnosed with duplex ultrasonography, 36 in 56 patients of previous-DVT group and 8 in 20 of non-previous-DVT group were found positive venous reflux. Most of venous reflux occurred at popliteal vein (77%) and posterior tibial vein (59%).
After TKA, the patients who developed DVT had higher risk to PTS (OR = 1.588). Treatment of DVT may not decrease this risk. Prevention of DVT becomes an important approach to prevent PTS.
深静脉血栓形成（DVT）是一种发病率较高的疾病，在接受全膝关节置换术（TKA）的患者中，有40%-60%会发病。血栓后综合征（PTS）是一种常见的长期并发症，可能在DVT发作后6个月内或2年以上出现。
研究TKA术后至少2年随访期内既往有DVT病史和无DVT病史患者的PTS患病率。
进行回顾性病历审查。纳入2002年10月至2005年期间接受TKA的所有患者。术后采用Villalta评分和双功超声在≥2年时对患者进行PTS评估。通过静脉造影确诊DVT。
根据临床评估，76例患者中有22例（既往有DVT病史56例，无DVT病史20例）患有PTS。既往有DVT病史组发生PTS的风险显著更高（OR = 1.59；95%CI：1.294-1.949；p值 = 0.001）。当采用双功超声诊断时，既往有DVT病史组的56例患者中有36例、无DVT病史组的20例患者中有8例发现静脉反流阳性。大多数静脉反流发生在腘静脉（77%）和胫后静脉（59%）。
TKA术后发生DVT的患者发生PTS的风险更高（OR = 1.588）。DVT的治疗可能无法降低这种风险。预防DVT成为预防PTS的重要方法。
