Tat-Sing Law Michael, McClure David N
Department of Vascular and Endovascular Surgery, Geelong Hospital, Geelong, Victoria, Australia.
ANZ J Surg. 2010 Apr;80(4):247-9. doi: 10.1111/j.1445-2197.2010.05244.x.
Recurrent spontaneous haemarthrosis after knee arthroplasty occurs in less than 1% of cases, commonly thought to be the result of impingement of hypertrophic vascular synovium or fat pads, and exacerbated by anti-coagulation or anti-platelet therapy. Traditional treatment comprises an initial period of rest followed by open or arthroscopic washout, and by synovectomy if bleeding recurs or fails to settle. We present three cases of recurrent haemarthrosis following knee arthroplasty, which were successfully treated by angiography and feeding vessel coil embolization. An injury to one of the genicular arteries was identified as the cause of bleeding in all three cases; one manifest as a traumatic arteriovenous fistula. Bleeding ceased in all cases without recurrence (follow-up period 6 months-5 years, median of 2 years). Endovascular treatment offers a minimally invasive treatment option in selected cases of recurrent post-operative haemarthrosis.
膝关节置换术后复发性自发性关节积血发生率低于1%，通常认为是肥厚的血管性滑膜或脂肪垫撞击所致，抗凝或抗血小板治疗会加重病情。传统治疗方法包括初期休息，随后进行开放或关节镜冲洗，若出血复发或未缓解则进行滑膜切除术。我们报告了3例膝关节置换术后复发性关节积血病例，通过血管造影和供血血管弹簧圈栓塞成功治愈。所有3例病例均发现膝部动脉之一损伤是出血原因；1例表现为创伤性动静脉瘘。所有病例出血均停止且未复发（随访期6个月至5年，中位时间为2年）。血管内治疗为部分复发性术后关节积血病例提供了一种微创治疗选择。
