Haake D A, Berkman S A
Department of Medicine, UCLA School of Medicine 90024.
Clin Orthop Relat Res. 1989 May(242):212-31.
Thromboembolism is a recognized complication of elective and emergency hip surgery. Because of the high incidence of venous thrombosis, prophylactic measures are necessary. Numerous modalities have been explored, and this review formulates strategies to prevent this potentially lethal complication. While minidose heparin and anti-platelet agents may provide effective thromboembolism protection for some patients, their effect in patients treated with hip surgery is limited. Dextran 40 is useful in younger patients treated with hip arthroplasty who are at risk for bleeding complications and who can tolerate volume overload. Heparin dihydroergotamine is an alternative to oral anticoagulants and may cause fewer bleeding complications than oral anticoagulants. Low molecular weight heparin and adjusted-dose heparin can also be used effectively in hip surgery. Warfarin is perhaps the most effective regimen when the prothrombin time is maintained at 1.2-1.5 times control. The risk of thrombosis for patients treated with either emergency or elective hip surgery is significant, and numerous additional factors can increase the likelihood of this complication. The best approach to this problem is prevention, which is effective, safe, and economical.
血栓栓塞是择期和急诊髋关节手术公认的并发症。由于静脉血栓形成的发生率很高，因此预防性措施是必要的。人们已经探索了多种方法，本综述制定了预防这种潜在致命并发症的策略。虽然小剂量肝素和抗血小板药物可能为一些患者提供有效的血栓栓塞保护，但它们在接受髋关节手术的患者中的效果有限。低分子右旋糖酐对接受髋关节置换术且有出血并发症风险且能耐受容量超负荷的年轻患者有用。肝素双氢麦角胺是口服抗凝剂的替代药物，可能比口服抗凝剂引起的出血并发症更少。低分子量肝素和调整剂量的肝素也可有效用于髋关节手术。当凝血酶原时间维持在对照值的1.2 - 1.5倍时，华法林可能是最有效的治疗方案。接受急诊或择期髋关节手术的患者发生血栓形成的风险很大，许多其他因素会增加这种并发症发生的可能性。解决这个问题的最佳方法是预防，这是有效、安全且经济的。
