关节镜下前交叉韧带重建术中的深静脉血栓形成与血栓预防
Deep vein thrombosis and thromboprophylaxis in arthroscopic anterior cruciate ligament reconstruction.
作者信息
Adala Raviraj, Anand Ashish, Kodikal Gautam
机构信息
Department of Orthopaedic Surgery, Fortis Hospitals Ltd., Bannerghatta Road, Bangalore, India.
出版信息
Indian J Orthop. 2011 Sep;45(5):450-3. doi: 10.4103/0019-5413.83952.
BACKGROUND
There is no clear evidence in the literature regarding the incidence of deep vein thrombosis (DVT) in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. Literature also lacks on the recommendations on thromboprophylaxis in patients undergoing elective arthroscopic ACL reconstruction. We conducted a prospective analysis to assess incidence of DVT in patients undergoing arthroscopic ACL reconstruction.
MATERIALS AND METHODS
120 consecutive patients with MRI proven ACL injury who were operated for arthroscopic ACL reconstruction were enrolled in this prospective study. None of the patients had risk factors (on history) for DVT, and all were below the age of 45 years. All cases were operated upon by a single surgeon and a standard rehabilitation regime was followed. The patients underwent clinical examination and screening (Doppler ultrasonography/venous scan) for any DVT, on the day prior to surgery, day of discharge (Day 3) and at 4 weeks postsurgery. None of the patients received any form of thromboprophylaxis against DVT.
RESULTS
One hundred and twelve patients (61 males and 51 females) completed the study. The average age was 31.6 years (range 24-42 years). All patients underwent arthroscopic assisted ACL reconstruction surgery within 3 weeks of the injury. Two patients (males) in the series had Doppler venous scan proven DVT. One patient was asymptomatic but the screening Doppler picked up the DVT on the third postoperative day. The other patient was symptomatic at 12 weeks with pain and swelling in the leg and had ultrasound -proven DVT.
CONCLUSION
In our study the incidence of deep vein thrombosis in patients undergoing arthroscopic ACL reconstruction is 1.78%. We do not recommend routine thromboprophylaxis in patients, who are not high risk candidates for thrombosis and are of less than 45 years, in patients undergoing arthroscopic ACL reconstruction, with early postoperative rehabilitation.
背景
文献中尚无关于关节镜下前交叉韧带（ACL）重建患者深静脉血栓形成（DVT）发生率的确切证据。对于择期关节镜下ACL重建患者的血栓预防建议，文献中也较为缺乏。我们进行了一项前瞻性分析，以评估关节镜下ACL重建患者DVT的发生率。
材料与方法
本前瞻性研究纳入了120例经MRI证实为ACL损伤并接受关节镜下ACL重建手术的连续患者。所有患者均无（病史方面的）DVT危险因素，且年龄均在45岁以下。所有病例均由同一位外科医生进行手术，并遵循标准的康复方案。患者在手术前一天、出院日（第3天）和术后4周接受临床检查及DVT筛查（多普勒超声检查/静脉扫描）。所有患者均未接受任何形式的DVT预防性治疗。
结果
112例患者（61例男性和5例女性）完成了研究。平均年龄为31.6岁（范围24 - 42岁）。所有患者均在受伤后3周内接受了关节镜辅助ACL重建手术。该系列中有2例男性患者经多普勒静脉扫描证实发生DVT。1例患者无症状，但术后第3天的筛查多普勒检查发现了DVT。另1例患者在术后12周出现症状，腿部疼痛和肿胀，经超声证实为DVT。
结论
在我们的研究中，关节镜下ACL重建患者深静脉血栓形成的发生率为1.78%。对于关节镜下ACL重建且术后早期进行康复的患者，若其并非血栓形成的高危人群且年龄小于45岁，我们不建议进行常规的血栓预防。
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