Namiki Koji, Nozawa Masahiko, Kim Sung-Gon, Sakamoto Yuko, Ochi Hironori, Kato Suguru, Ishijima Muneaki
Juntendo Iji Zasshi. 2022 Sep 9;68(5):491-498. doi: 10.14789/jmj.JMJ21-0056-OA. eCollection 2022.
Postoperative venous thromboembolism is an important peri-operative complication associated with total hip arthroplasty (THA). In particular, early detection of deep venous thrombosis (DVT) is important for the prevention of pulmonary embolism (PE). However, the methods and timing of examinations for DVT detection differ among the facilities. This study aimed to clarify the time, site, and frequency of DVT after THA.
Background characteristics including age, sex, body mass index, diagnosis, operation type, operation time, and anesthesia type were investigated in 348 patients who underwent THA at our hospital between April 2017 and April 2019. Blood tests were performed preoperatively and on postoperative days (POD) 0, 1, 3, 7, 14, and 21. Simultaneously, vascular ultrasonography was performed to investigate the time and site of thrombus occurrence before and after the surgery.
DVT was observed in 27.2% of the patients on POD 21. The DVT-positive ratio was 9.4% (6/64) in males and 31.3% (89/284) in females. There was a significant difference between the groups ( = 0.0002). Patients in the DVT-positive group were significantly older than those in the DVT-negative group (73.0 ± 7.9 years vs. 63.3 ± 11.2 years, = 0.0041). DVT mainly occurred in the soleal vein (74.7%). However, there was no significant difference between the operated and non-operated sides. In the DVT-positive group, thrombus occurred in 13.3% of preoperative cases, 20.0% on POD 0, 46.7% on POD 1, 13.3% on POD 3, 6.7% on POD 7, and 0% on POD 14 and 21.
Vascular ultrasonography showed that thrombus occurred most frequently in the soleal vein. Thrombus occurred in 66.6% of DVT-positive patients by POD 1, indicating that thrombus appeared very early after surgery. All thrombus cases were formed by POD 7.
术后静脉血栓栓塞是全髋关节置换术（THA）相关的重要围手术期并发症。特别是，早期发现深静脉血栓形成（DVT）对于预防肺栓塞（PE）很重要。然而，不同医疗机构检测DVT的方法和时间有所不同。本研究旨在明确THA术后DVT发生的时间、部位和频率。
对2017年4月至2019年4月在我院接受THA的348例患者的背景特征进行调查，包括年龄、性别、体重指数、诊断、手术类型、手术时间和麻醉类型。术前以及术后第（POD）0、1、3、7、14和21天进行血液检查。同时，进行血管超声检查以调查手术前后血栓形成的时间和部位。
术后第21天，27.2%的患者观察到DVT。男性DVT阳性率为9.4%（6/64），女性为31.3%（89/284）。两组之间存在显著差异（=0.0002）。DVT阳性组患者的年龄显著高于DVT阴性组（73.0±7.9岁对63.3±11.2岁，=0.0041）。DVT主要发生在比目鱼肌静脉（74.7%）。然而，手术侧与非手术侧之间无显著差异。在DVT阳性组中，术前病例血栓形成率为13.3%，POD 0为20.0%，POD 1为46.7%，POD 3为13.3%，POD 7为6.7%，POD 14和21为0%。
血管超声检查显示血栓最常发生在比目鱼肌静脉。到POD 1时，66.6%的DVT阳性患者出现血栓，表明血栓在术后很早就出现了。所有血栓病例均在POD 7时形成。
