Morris John K, Fincham Bryce M
Department of Surgery, St Joseph Mercy Health System, Ann Arbor, Michigan 48106-0995,
Orthopedics. 2012 Dec;35(12):e1716-21. doi: 10.3928/01477447-20121120-15.
Venous thromboembolism (VTE) prophylaxis in total knee arthroplasty (TKA) is controversial. The purpose of this study was to evaluate the efficacy of bilateral intra- and postoperative intermittent pneumatic compression without major anticoagulation as prophylaxis for VTE in TKA.This retrospective study involved 157 consecutive patients undergoing TKA performed by 1 surgeon who were treated with bilateral intra- and postoperative intermittent pneumatic compression stockings. All patients were followed for at least 6 weeks postoperatively. Postoperative color duplex ultrasound imaging with compression by certified vascular technologists was obtained for 120 patients 2 to 3 days postoperatively. During hospitalization, 2 (1.7%) patients had acute deep vein thrombosis (DVT) diagnosed, 2 (1.7%) had DVT of indeterminate age, and 4 (3.3%) had chronic DVT. During follow-up, 1 (0.8%) patient had an acute DVT diagnosed at 5 weeks postoperatively and 1 (0.8%) had a superficial phlebitis and subsequently had a nonfatal pulmonary embolism 23 days postoperatively. The predominant chemoprophylaxis used was aspirin alone in 107 (89.2%) patients. Epidural anesthesia was used in the majority (n=96; 80%) of patients.The results of this study support the use of a multimodal approach to VTE prophylaxis in TKA, using bilateral intra- and postoperative intermittent pneumatic compression, epidural anesthesia, early mobilization, and postoperative aspirin without the use of major anticoagulation as an effective, safe VTE prophylactic protocol for patients undergoing elective TKA. The study suggests that the protocol is highly effective, has low morbidity, and is cost effective.
全膝关节置换术（TKA）中静脉血栓栓塞症（VTE）的预防存在争议。本研究的目的是评估双侧术中和术后间歇性气动压迫在不进行主要抗凝治疗的情况下对TKA患者VTE预防的效果。这项回顾性研究纳入了157例连续接受同一位外科医生进行TKA手术的患者，他们均接受了双侧术中和术后间歇性气动压迫袜治疗。所有患者术后至少随访6周。术后2至3天，120例患者由认证血管技术人员进行了彩色双功超声成像及压迫检查。住院期间，2例（1.7%）患者被诊断为急性深静脉血栓形成（DVT），2例（1.7%）有年龄不确定的DVT，4例（3.3%）有慢性DVT。随访期间，1例（0.8%）患者在术后5周被诊断为急性DVT，1例（0.8%）有浅静脉炎，随后在术后23天发生了非致命性肺栓塞。107例（89.2%）患者主要使用的化学预防药物是阿司匹林。大多数患者（n = 96；80%）使用了硬膜外麻醉。本研究结果支持在TKA中采用多模式VTE预防方法，即使用双侧术中和术后间歇性气动压迫、硬膜外麻醉、早期活动及术后使用阿司匹林，而不进行主要抗凝治疗，作为接受择期TKA患者有效、安全的VTE预防方案。该研究表明该方案高效、发病率低且具有成本效益。
