Colwell Clifford W
Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.
Orthopedics. 2009 Dec;32(12 Suppl):67-73. doi: 10.3928/01477447-20091103-51.
The 1986 National Institutes of Health consensus conference Prevention of Venous Thrombosis and Pulmonary Embolism emphasized the high rates of venous thromboembolic disease (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), associated with orthopedic surgery of the lower extremity when performed without thromboprophylaxis. Total joint arthroplasty patients treated with placebo or as controls have, based on studies conducted between 1908 and 2002, a total DVT prevalence of 41% to 85% and a proximal DVT prevalence of 5% to 36% when examined by venography at 7 to 14 days. Prevalence of PE is less certain, but clinical studies have reported a range of 0.9% to 28% for all PE and 0.1% to 2% for fatal PE in control or placebo patients. As the number of total joint arthroplasties in the United States has grown - nearing 1,000,000 annually and expected to increase significantly over the next 20 years as the population ages - so too has interest in appropriate thromboprophylaxis. Methods of preventing VTE are either pharmacologic or mechanical. Guidelines from the American College of Chest Physicians make evidence-based recommendations for both pharmacologic and nonpharmacologic prophylaxis in the settings of total hip and total knee arthroplasty. These recommendations and their underlying rationale are discussed herein.
1986年美国国立卫生研究院关于预防静脉血栓形成和肺栓塞的共识会议强调，在未进行血栓预防的情况下，下肢骨科手术相关的静脉血栓栓塞性疾病（VTE）发生率很高，包括深静脉血栓形成（DVT）和肺栓塞（PE）。根据1908年至2002年期间开展的研究，接受安慰剂治疗或作为对照的全关节置换术患者，在术后7至14天通过静脉造影检查时，总的DVT患病率为41%至85%，近端DVT患病率为5%至36%。PE的患病率不太确定，但临床研究报告称，对照或安慰剂组患者中，所有PE的患病率为0.9%至28%，致命性PE的患病率为0.1%至2%。随着美国全关节置换术数量的增加——每年接近100万例，并且预计在未来20年随着人口老龄化将显著增加——对适当血栓预防的关注也在增加。预防VTE的方法包括药物预防和机械预防。美国胸科医师学会的指南针对全髋关节置换术和全膝关节置换术的药物预防和非药物预防给出了基于证据的建议。本文将讨论这些建议及其基本原理。
