[1]扈鑫,高石军,董江涛,等.中老年全膝关节置换术后下肢深静脉血栓形成的解剖部位分布特点[J].中华老年骨科与康复电子杂志,2017,(05):296-301.[doi:10.3877/cma.j.issn.2096-0263.2017.05.009]
　Hu Xin,Gao Shijun,Dong Jiangtao,et al.The anatomical distribution of lower extremity deep vein thrombosis of middle-aged, and older patients after total knee arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):296-301.[doi:10.3877/cma.j.issn.2096-0263.2017.05.009]
点击复制

中老年全膝关节置换术后下肢深静脉血栓形成的解剖部位分布特点()
分享到：

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2017年05期
页码:
296-301
栏目:
下肢
出版日期:
2017-09-18

文章信息/Info

Title:
The anatomical distribution of lower extremity deep vein thrombosis of middle-aged, and older patients after total knee arthroplasty
作者:
扈鑫; 高石军; 董江涛; 李彤; 王娟; 郑晓佐; 康凯; 余青洲; 程轩洁
050051 石家庄，河北医科大学第三医院关节外科
Author(s):
Hu Xin;  Gao Shijun;  Dong Jiangtao;  Li Tong;  Wang Juan;  Zheng Xiaozuo;  Kang Kai;  Yu Qingzhou;  Cheng Xuanjie
Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
关键词:
静脉血栓形成;  关节成形术; 置换; 膝;  超声检查
Keywords:
Venous thrombosis;  Arthroplasty;  replacement;  knee;  Ultrasonography
DOI:
10.3877/cma.j.issn.2096-0263.2017.05.009
文献标志码:
A
摘要:
目的 探讨中老年患者行初次全膝关节置换术（TKA）后下肢深静脉血栓形成的解剖分布特点及差异。方法 回顾性分析2013年6月至2015年12月接受初次TKA后经彩色多普勒超声诊断下肢深静脉血栓形成的中老年患者137例。根据年龄段分为A组（51～60岁）、B组（61～70岁）以及C组（71～80岁），分别于术后第3～5天行下肢深静脉彩超，观察三组患者术后下肢深静脉血栓形成的部位及其差异。结果 所有患者均获得满意随访，随访时间为1～2个月。A组中，混合型血栓2例（3.8%）、周围型血栓47例（90.4%）、中央型血栓3例（5.8%）；B组中，混合型血栓8例（13.5%）、周围型血栓50例（84.8%）、中央型血栓1例（1.7%）；C组中，混合型血栓8例（41.7%）、周围型血栓14例（50%）、中央型血栓4例（8.3%）。三组患者的血栓类型比较差异具有统计学意义（c2=18.403，P＜0.05）。A组患者最易累及的深静脉为肌间静脉（79.2%），其次是腓静脉（15.1%）、胫后静脉（13.2%）、腘静脉（7.5%）、髂股静脉（1.9%）；而B组，最易累及静脉为肌间静脉（91.5%），其次为腘静脉（16.9%）、胫后静脉（15.2%）、腓静脉（11.8%）；C组最易累及的深静脉为肌间静脉（61.5%），其次是腓静脉（42.3%）、腘静脉（34.6%）、胫后静脉（23%）、髂股静脉（7.7%），三组间差异有统计学意义（c2=18.024，P＜0.05）。在孤立性血栓中，以肌间静脉血栓形成最为多见。在多支静脉血栓中，三组均以累及胫后静脉、腓静脉、肌间静脉血栓中的两支或三支常见。结论 肌间静脉是行膝关节TKA术后DVT患者最易累及的静脉。TKA后不同年龄组间下肢深静脉血栓形成的解剖分布不同。随着患者年龄增加，更易发生混合型DVT，同时中心静脉血栓发生率也会提高。
Abstract:
Objective To analyze the anatomical distribution of lower extremity deep vein thrombosis (DVT) in middle-aged, and older patients after total knee arthroplasty (TKA). Methods Data of 137 patients with lower extremity DVT confirmed by color doppler ultrasound (CDFII) after TKA from June 2013 to December 2015 were analyzed in a retrospective study, they were divided into three groups according to age, there were 52 cases in group A (51-60 years), 59 cases in group B (61-70 years) and 26 cases in group C (71-80 years). The anatomical distribution of lower extremity DVT after TKA in different age groups was analyzed and compared by color doppler ultrosound at 3 to 5 days after surgery. Results All patients were followed-up with a time span of 1-2 months. There were 2 mixed DVT (3.8%), 47 (90.4%) peripheral DVT, and 3 (5.8%) central DVT in group A. In group B, there were 1 (1.7%) central DVT, 50 (84.8%) peripheral DVT and 8 (13.5%) mixed DVT. In group C, there were 4 (8.3%) central DVT, 14 (50%) peripheral DVT and 8 (41.7%) mixed DVT. There were significant differences among three groups in DVT distribution (c2=18.403, P＜0.05). In group A, intramuscular veins were the dominate type (79.2%), with a ddecreased likelihood of peroneal veins (15.1%), posterior tibial veins (13.2%), popliteal veins (7.5%) and iliofemoral veins (1.9%). In group B, intramuscular veins were most frequently (91.5%), with a decreased likelihood of popliteal veins (16.9%), posterior tibial veins (15.2%) and peroneal veins (11.8%). In group C patients, intramuscular veins were the dominant type(61.5%), with a decreased likelihood of peroneal veins (42.3%), popliteal veins (34.6%), posterior tibial veins (15.2%) and iliofemoral veins (7.7%). There was a statistically significant difference among three groups (c2=18.024, P＜0.05). Intramuscular veins were the commonest type in isolated DVT. The thrombsis often concomitantly occured in two or three veins of posterior tibial veins, peroneal veins and intramuscular veins in patients with multiple DVT. Conclusion DVT in patients after TKA mostly involved intra muscular veins. There is a statistically significant difference of DVT anatomical distribution after TKA in different age groups. Along with the aging process, the elderly are more likely to develop mixed DVT and popliteal vein thrombosis.

参考文献/References:

1 邱贵兴, 杨庆铭, 余楠生, 等. 低分子肝素预防髋、膝关节手术后下肢深静脉血栓形成的多中心研究 [J]. 中华骨科杂志, 2006, 26(12): 819-822.
2 Piovella F, Wang CJ, Lu H, et al. Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography [J]. J Thromb Haemost, 2005, 3(12): 2664-2670.
3 Chan WS, Spencer FA, Ginsberg JS. Anatomic distribution of deep vein thrombosis in pregnancy [J]. CMAJ, 2010, 182(7): 657-660.
4 Agarwala S, Bhagwat AS, Modhe J. Deep vein thrombosis in Indian patients undergoing major lower limb surgery [J]. Indian J Surg, 2003, 65(2): 159-162.
5 姚尧, 张成绩, 戴小宇, 等. 关节置换术后下肢深静脉血栓形成的解剖分布 [J]. 中华骨科杂志, 2013, 33(9): 912-916.
6 许鹏飞, 尹宗生, 高维陆, 等. 全膝关节置换流行病学分析:2008至2013年合肥市1146例回顾 [J]. 中国组织工程研究, 2015, 4(4): 504-509.
7 徐英江, 金毕, 杨超, 等. 459例肺栓塞临床特点分析 [J]. 中华普通外科杂志, 2015, 30(12): 979-982.
8 罗小云, 张福先, 张昌明, 等. 急性下肢深静脉血栓形成后肺栓塞严重程度的危险因素分析 [J]. 中华外科杂志, 2015, 53(8): 580-583.
9 Huber D, Huber J, Deyoung E. The association between popliteal vein compression and deep venous thrombosis:results of a pilot study [J]. Phlebology, 2013, 28(6): 305-307.
10 杨明辉, 朱仕文, 孙旭, 等. 骨盆髋臼骨折后深静脉血栓形成的诊断:彩色多普勒超声与静脉造影的比较研究 [J]. 中华创伤骨科杂志, 2012, 14(5): 391-394.
11 张海波, 何炜. 骨科下肢深静脉血栓防治的经验及教训 [J]. 中国骨与关节损伤杂志, 2012, 27(2): 185-186.
12 乔福斌, 田忠, 何艳丽. 疏血通联合低分子肝素对下肢骨折形成深静脉血栓的疗效观察 [J]. 西南国防医药, 2008, 8(6): 846-847.
13 Dunbar NM, Chandler WL. Thrombin generation in trauma patients [J]. Transfusion, 2009, 49(12): 2652-2660.
14 Dong- II C, Seong MK, Yun S, et al. Hybrid operation for arteriovenous malformation in left soleus muscle with embolizationof feeding artery and En bloc resection:a case report [J]. J Korean Foot Ankle Soc, 2015, 19(1): 23-26.
15 王晓玲, 洪星禹, 曹忠文. 老年人下肢深静脉血栓的治疗 [J]. 中国老年学杂志, 2015, 8(8): 2253-2254.
16 Izumi M, Ikeuchi M, Aso K, et al. Less deep vein thrombosis due to transcutaneous fibular nerve stimulation in total knee arthroplasty: a randomized controlled trial [J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(11): 3317-3323.
17 Vedantham S. Deep venous thrombosis: the opportunity at hand [J]. AJR Am J Roentgenol, 2009, 193(4): 922-927.
18 Kim YH, Kim JS. Incidence and natural history of deep-vein thrombosis after total knee arthroplasty. A prospective, randomised study [J]. J Bone Joint Surg Br, 2002, 84(4): 566·570．
19 Wang CJ, Wang JW, Weng LH, et al. Outcome of calf deep-vein thrombosis after total knee arthroplasty [J]. J Bone Joint Surg Br, 2003, 85(6): 841-844.
20 Joseph FD, Dominic P, Samir HM, et al. Daily hospitalization costs in patients with deep vein thrombosis or pulmonary embolism treated with anticoagulant therapy [J]. Thromb Res, 2015, 125(2): 303-310.
21 Kageyama N, Ro A, Tanifuji T, et al. Significance of the soleal vein and its drainage veins in cases of massive pulmonary thromboembolism [J]. Ann Vasc Dis, 2008, 1(1): 35-39.
22 田锦林, 王海峰, 屈尔青, 等. 下肢深静脉血栓患者非高危肺栓塞危险的多因素分析 [J]. 中国临床医学影像杂志, 2015, 26(10): 692-695.
23 Ikeda Y, Yoshimura N, Hori Y, et al. Analysis of decrease in lung perfusion blood volume with occlusive and non-occlusive pulmonary embolisms [J]. Eur J Radiol, 2014, 83(12): 2260-2267.
24 胡潍青, 孙波, 裴长安, 等. 超声引导下经腘静脉置管溶栓治疗急性下肢深静脉血栓形成 [J]. 中华普通外科杂志, 2015, 30(4): 260-263.

相似文献/References:

[1]徐明 付志厚 孙海宁 曲新涛 于秀淳.腓骨近端截骨与单髁关节置换治疗膝关节内侧单间室骨关节炎的疗效比较[J].中华老年骨科与康复电子杂志,2016,(01):26.[doi:10.3877/cma.j.issn.2096-0263.2016.01.006]
　Xu Ming,Fu Zhihou,Sun Haining,et al.Comparison study of proximal fibular osteotomy versus unicompartmental knee arthroplasty for medialcompartment osteoarthritis of the knee[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):26.[doi:10.3877/cma.j.issn.2096-0263.2016.01.006]
[2]杨朝君 孙智文 田洪涛.腓骨近端截骨术与人工全膝关节置换术治疗内翻型膝关节骨关节炎的短期疗效比较[J].中华老年骨科与康复电子杂志,2016,(01):38.[doi:10.3877/cma.j.issn.2096-0263.2016.01.008]
　Yang Zhaojun,Sun Zhiwen,Tian Hongtao.Comparison on the short term treatment of varus knee osteoarthritis by proximal fibular osteotomy versus total knee arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):38.[doi:10.3877/cma.j.issn.2096-0263.2016.01.008]
[3]李雪靖,张雪松,刘思思,等.腓骨近端截骨联合关节镜下清理治疗内翻型膝关节骨关节炎的成本效果分析[J].中华老年骨科与康复电子杂志,2016,(04):222.[doi:10.3877/cma.j.issn.2096-0263.2016.04.006]
　Li Xuejing,Zhang Xuesong,Liu Sisi,et al.Cost-effectiveness analysis of proximal fibular osteotomy combined with arthroscopy debridement for medial compartment knee ostoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):222.[doi:10.3877/cma.j.issn.2096-0263.2016.04.006]
[4]张静,李志锐,唐佩福.老年粗隆间骨折的手术治疗进展[J].中华老年骨科与康复电子杂志,2016,(04):250.[doi:10.3877/cma.j.issn.2096-0263.2016.04.011]
　Li Zhirui,Zhang Jing,Tang Peifu.Progress of surgical treatment for femoral intertrochanteric fracture in the elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):250.[doi:10.3877/cma.j.issn.2096-0263.2016.04.011]
[5]李涛,王英振,李玉龙,等.骨水泥与非骨水泥半髋关节置换治疗老年股骨颈骨折安全性的 Meta分析[J].中华老年骨科与康复电子杂志,2017,(02):109.[doi:10.3877/cma.j.issn.2096-0263.2017.02.008]
　Li Tao,Wang Yingzhen,Li Yulong,et al.Safety of cement and cementless hemiarthroplasty for femoral neck fractures in elderly patients: a meta- analysis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):109.[doi:10.3877/cma.j.issn.2096-0263.2017.02.008]
[6]陈佳,李西成.髋部骨折：争议与挑战[J].中华老年骨科与康复电子杂志,2017,(04):193.[doi:10.3877/cma.j.issn.2096-0263.2017.04.001]
　Chen Jia,Li Xicheng.Hip fracture: Controversy and challenge[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):193.[doi:10.3877/cma.j.issn.2096-0263.2017.04.001]
[7]贾建波,禹宝庆,吴良浩,等.传统后路与微创 SuperPath入路的半髋置换治疗老年股骨颈骨折疗效比较[J].中华老年骨科与康复电子杂志,2017,(04):223.[doi:10.3877/cma.j.issn.2096-0263.2017.04.006]
　Jia Jianbo,Yu Baoqing,Wu Lianghao,et al.Hip hemiarthroplasty for senile femoral neck fractures: minimally invasive SuperPath approach versus traditional posterior approach[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):223.[doi:10.3877/cma.j.issn.2096-0263.2017.04.006]
[8]姚尧,乔梁,王业贤,等.床旁超声在股骨颈骨折患者围手术期下肢深静脉血栓筛查中的作用[J].中华老年骨科与康复电子杂志,2018,(02):70.[doi:10.3877/cma.j.issn.2096-0263.2018.02.002]
　Yao Yao,Qiao Liang,Wang Yexian,et al.The clinical value of bedside ultrasound in the screening of perioperative lower extremity deep vein thrombosis in elderly patients with femoral neck fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(05):70.[doi:10.3877/cma.j.issn.2096-0263.2018.02.002]
[9]黄子达,张子杰,李文波,等.多模式预防措施对老年关节置换术后静脉血栓栓塞症发生及转归的影响[J].中华老年骨科与康复电子杂志,2018,(02):80.[doi:10.3877/cma.j.issn.2096-0263.2018.02.004]
　Huang Zida,Zhang Zijie,Li Wenbo,et al.Incidence and outcome of postoperative venous thromboembolism in elderly patients underwent knee or hip arthroplasty with multimodal thromboprophylaxis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(05):80.[doi:10.3877/cma.j.issn.2096-0263.2018.02.004]
[10]董航,沈先月,李昊轩,等.基于三维重建技术的国人肩关节盂三维形态学测量与研究[J].中华老年骨科与康复电子杂志,2018,(02):98.[doi:10.3877/cma.j.issn.2096-0263.2018.02.007]
　Dong Hang,Shen Xianyue,Li Haoxuan,et al.Morphological measurement and analysis of normal glenoid fossa in Chinese population by application of three-dimensional reconstruction[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(05):98.[doi:10.3877/cma.j.issn.2096-0263.2018.02.007]
[11]楚翔宇,程文俊,王俊文,等.老年股骨颈骨折全髋关节置换术围手术期下肢深静脉血栓形成的特点[J].中华老年骨科与康复电子杂志,2018,(02):75.[doi:10.3877/cma.j.issn.2096-0263.2018.02.003]
　Chu Xiangyu,Cheng Wenjun,Wang Junwen,et al.Features of deep venous thrombosis in aged patients with femoral neck fracture during the perioperative period[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(05):75.[doi:10.3877/cma.j.issn.2096-0263.2018.02.003]
[12]孔刚,马卫华,张树栋.单侧与双侧使用间歇充气加压在预防髋膝置换术后DVT中的效果比较[J].中华老年骨科与康复电子杂志,2019,(01):13.[doi:10.3877/cma.j.issn.2096-0263.2019.01.004]
　Kong Gang,Ma Weihua,Zhang Shudong.Comparison of the effect of IPC on non operative side and bilateral sides in DVT prevention after hip and knee replacement[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(05):13.[doi:10.3877/cma.j.issn.2096-0263.2019.01.004]
[13]胡鸿鹏,刘泽明,高勇岗,等.吲哚布芬预防老年髋关节置换术后下肢深静脉血栓的临床研究[J].中华老年骨科与康复电子杂志,2019,(01):19.[doi:10.3877/cma.j.issn.2096-0263.2019.01.005]
　Hu Hongpeng,Liu Zeming,Gao Yonggang,et al.Clinical study of indolbufen in preventing deep vein thrombosis of lower extremity after hip arthroplasty in elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(05):19.[doi:10.3877/cma.j.issn.2096-0263.2019.01.005]

备注/Memo

备注/Memo:
基金项目：河北省卫生厅重大项目（H2013206364）
更新日期/Last Update: 2017-09-15