Incidence and natural history of deep-vein thrombosis after total knee arthroplasty - A prospective, randomised study
Incidence and natural history of deep-vein thrombosis after total knee arthroplasty - A prospective, randomised study
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DOI：
10.1302/0301-620x.84b4.12330
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发表时间：
2002-05-01
影响因子：
--
通讯作者：
Kim, JS
中科院分区：
文献类型：
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作者：
Kim, YH;Kim, JS
我们前瞻性地评估了深静脉血栓形成（DVT）的发生率和位置，肺栓塞的危险因素，以及未接受DVT预防性或治疗性治疗的全膝关节置换术（TKR）后血栓形成的自然史。我们研究了227例接受初次TKR的患者; 116例接受一期双侧手术，111例接受单侧手术。在三个不同的场合对所有患者进行凝血试验、全血细胞计数和血清化学特征的血型分型试验。术后六天或七天进行双侧同时或单侧静脉造影。术前及术后7 ~ 8d行肺灌注扫描。所有有血栓的患者在术后6个月重复双侧同时或单侧静脉造影，在116例双侧置换患者中，232例静脉造影中有97例（41.8%）新鲜血栓阳性，而在111例单侧置换患者中有46例阳性静脉造影（41.4%）（p = 1.000）。在116例骨水泥置换膝关节的静脉造影中，45例（38.8%）血栓阳性，而在116例非骨水泥置换膝关节的静脉造影中，52例（44.8%）血栓阳性（p = 0.675）。术后6个月，所有143条有血栓的肢体的进一步静脉造影显示，无论大小或位置，所有血栓均已完全消退。肺灌注扫描阴性显示无肺栓塞发生，且无症状。尽管目前流行的观点是近端静脉血栓形成的患者应接受抗凝治疗，但我们的研究表明，所有血栓无论大小或位置均消退，且不引起肺栓塞。
We have evaluated prospectively the incidence and location of deep-vein thrombosis (DVT), the risk factors for pulmonary embolism, and the natural history of thrombosis after total knee replacement (TKR) in patients who did not receive prophylactic or therapeutic treatment for DVT.We studied 227 patients who underwent primary TKR; 116 had one-stage bilateral and 111 unilateral procedures. Coagulation assays, the full blood count and blood typing tests for the serum chemical profile were undertaken in all patients on three separate occasions. Bilateral simultaneous or unilateral venograms were carried out at six or seven days after operation. Perfusion lung scanning was undertaken before and at seven or eight days after operation. Bilateral simultaneous or unilateral venograms were repeated six months after operation in all patients who had thrombi.In the 116 patients with a bilateral replacement, 97 of 232 venograms (41.8%) were positive for fresh thrombi while there were 46 positive venograms (41.4%) in the 111 patients with a unilateral replacement (p = 1.000). Of the 116 venograms in knees with a cemented replacement, 45 (38.8%) were positive for thrombi while 52 of the 116 venograms (44.8%) were positive in those with a cementless replacement (p = 0.675). Further venograms at six months after operation in all 143 limbs which had thrombi showed that all had completely resolved regardless of the size or location. No pulmonary embolism occurred as shown by negative perfusion lung scans and the absence of symptoms.Although the current prevailing opinion is that patients with thrombosis in the proximal veins should receive anticoagulant treatment, our study has shown that all thrombi regardless of their size or location resolved without causing pulmonary embolism.