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择期髋关节镜检查后近端深静脉血栓形成的发生率:一项针对低风险患者的前瞻性队列研究。

The incidence of proximal deep vein thrombosis after elective hip arthroscopy: a prospective cohort study in low risk patients.

作者信息

Mohtadi Nicholas G, Johnston Kelly, Gaudelli Cinzia, Chan Denise S, Barber Rhamona S, Walker Richard, Patel Chirag, Mackay Elizabeth, Oddone Paolucci Elizabeth

机构信息

University of Calgary Sport Medicine Centre, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.

Alberta Hip & Knee Clinic - Calgary, Suite 335, 401 9th Ave SW, Calgary, AB T2P 3C5, Canada.

出版信息

J Hip Preserv Surg. 2016 Aug 18;3(4):295-303. doi: 10.1093/jhps/hnw027. eCollection 2016 Oct.

Abstract

Prospectively assess the incidence of deep venous thrombosis (DVT) using Doppler Ultrasound, in patients receiving elective hip arthroscopy without pharmacologic/mechanical prophylaxis. One hundred and fifteen consecutive patients (mean 35.4 years, SD = 10.3) underwent elective hip arthroscopy. Patients with previous major risk factors for DVT were excluded. Signs/symptoms of DVT/pulmonary embolism were assessed at 2-week post-operatively. A bilateral whole leg Duplex color (Doppler) Ultrasonography was scheduled between 10- and 22-day post-op. The primary outcome was frequency of DVT. Secondary outcomes assessed surgical risk factors. One hundred and ten patients (mean = 34.3 years, SD = 10.1) did not get a DVT. Five patients (mean = 43.8 years, SD = 12.1) were diagnosed with a DVT, 2- to 22-day post-operatively. All DVT patients received arthroscopy in the supine position ( = 76), versus no patients in the lateral position ( = 39). Average traction time was 38 (SD = 4) and 61 (SD = 4) minutes for patients with and without a DVT, respectively. All other a priori defined risk factors were similar. Four out of five patients presented with symptoms of a DVT, confirmed by ultrasound. One patient was without symptoms/clinical findings. Four patients had a DVT restricted to the calf veins; one patient had involvement of the popliteal vein. No patients had proximal extension into the thigh or pelvis. No pulmonary emboli were suspected or occurred. The incidence of deep venous thromboembolism is 4.3%. The majority of patients had symptomatic and distal venous thromboembolic events. This study provides supportive evidence that routine prophylaxis and/or screening may not be necessary in low risk patients undergoing elective hip arthroscopy.

摘要

在未接受药物/机械预防的择期髋关节镜手术患者中,使用多普勒超声前瞻性评估深静脉血栓形成(DVT)的发生率。115例连续患者(平均35.4岁,标准差=10.3)接受了择期髋关节镜手术。排除既往有DVT主要危险因素的患者。术后2周评估DVT/肺栓塞的体征/症状。计划在术后10至22天进行双侧全腿双功彩色(多普勒)超声检查。主要结局是DVT的发生率。次要结局评估手术危险因素。110例患者(平均=34.3岁,标准差=10.1)未发生DVT。5例患者(平均=43.8岁,标准差=12.1)在术后2至22天被诊断为DVT。所有发生DVT的患者均在仰卧位接受关节镜检查(n=76),而侧卧位无患者发生DVT(n=39)。发生DVT和未发生DVT的患者平均牵引时间分别为38(标准差=4)和61(标准差=4)分钟。所有其他预先定义的危险因素相似。5例患者中有4例出现DVT症状,经超声证实。1例患者无症状/临床发现。4例患者的DVT局限于小腿静脉;1例患者的腘静脉受累。没有患者近端延伸至大腿或骨盆。未怀疑或发生肺栓塞。深静脉血栓栓塞的发生率为4.3%。大多数患者发生有症状的远端静脉血栓栓塞事件。本研究提供了支持性证据,表明对于接受择期髋关节镜手术的低风险患者,可能无需常规预防和/或筛查。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d52/5883170/a6310d1c64b8/hnw027f1p.jpg

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