Davidson H C, Mazzu D, Gage B F, Jeffrey R B
Department of Diagnostic Radiology and Nuclear Medicine, Stanford University Medical Center, CA 94305, USA.
AJR Am J Roentgenol. 1996 Mar;166(3):659-62. doi: 10.2214/ajr.166.3.8623645.
The purpose of our study was to assess the prevalence and risk factors for sonographically detectable lower extremity deep venous thrombosis (DVT) in asymptomatic patients following major orthopedic surgery.
We performed color Doppler sonography of the lower extremities in 474 asymptomatic patients following major hip or knee surgery. We determined the prevalence of lower extremity DVT and used stepwise logistic regression to identify factors predictive of DVT. All patients received routine prophylactic measures.
The prevalence of DVT was 7%. Laterality of surgery, age, and gender were all independent predictors of DVT (p < or = .01): the odds of having DVT were 20 times higher in the leg that was operated upon than in the leg that was not; the odds of DVT rose by a factor of 1.5 per decade of life; and the odds of DVT were 3.4 times greater in men than in women. DVT was more common in patients who had received general rather than epidural anesthesia, with borderline significance (p = .06). The length of anesthesia and the joint involved (hip or knee) were not predictive of DVT (p > .10).
Despite prophylaxis, DVT is a relatively common postoperative complication in patients who undergo major orthopedic procedures. Routine screening for DVT is warranted in asymptomatic patients who have undergone hip or knee surgery, and color Doppler sonography, despite its limitations, offers a reasonably accurate noninvasive method for screening these patients. Subsets of patients who are at particular risk include the elderly, male patients, and patients who have undergone general anesthesia. The low prevalence of DVT in limbs not operated upon suggests that routine screening may be limited to evaluating the affected limbs only, thus helping to minimize the cost of screening.
我们研究的目的是评估大型骨科手术后无症状患者中超声可检测到的下肢深静脉血栓形成（DVT）的患病率及危险因素。
我们对474例接受大型髋部或膝部手术后无症状的患者进行了下肢彩色多普勒超声检查。我们确定了下肢DVT的患病率，并采用逐步逻辑回归分析来识别DVT的预测因素。所有患者均接受常规预防措施。
DVT的患病率为7%。手术部位、年龄和性别均为DVT的独立预测因素（p≤0.01）：手术侧下肢发生DVT的几率比未手术侧高20倍；DVT的几率每增加十岁上升1.5倍；男性发生DVT的几率是女性的3.4倍。接受全身麻醉而非硬膜外麻醉的患者中DVT更常见，具有临界显著性（p = 0.06）。麻醉时间和受累关节（髋部或膝部）不是DVT的预测因素（p＞0.10）。
尽管采取了预防措施，但DVT在接受大型骨科手术的患者中仍是一种相对常见的术后并发症。对于接受髋部或膝部手术的无症状患者，有必要进行DVT的常规筛查，彩色多普勒超声尽管有其局限性，但为筛查这些患者提供了一种相当准确的非侵入性方法。特别高危的患者亚组包括老年人、男性患者以及接受全身麻醉的患者。未手术肢体中DVT的低患病率表明常规筛查可能仅限于评估受累肢体，从而有助于将筛查成本降至最低。
