中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (35): 6636-6638.doi: 10.3969/j.issn.1673-8225.2010.35.044

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

老年单侧全髋关节置换与下肢深静脉血栓形成

庞  灵，海德静，王  锐，宗敏茹，于敏华，杨玉辉   

  1. 吉林大学中日联谊医院康复医学科，吉林省长春市  130033
  • 出版日期:2010-08-27 发布日期:2010-08-27
  • 通讯作者: 杨玉辉，主治医师，吉林大学中日联谊医院康复医学科，吉林省长春市 130033
  • 作者简介:庞灵★，女，1974年生，汉族， 2008年吉林大学公共卫生学院毕业，硕士，主管护师，主要从事下肢深静脉血栓形成的基础及临床研究。
  • 基金资助:

     长春市科委资助项目(01-126S50)。

Deep venous thrombosis in the lower limbs and unilateral total hip replacement in the elderly

Pang Ling, Hai De-jing, Wang Rui, Zong Min-ru, Yu Min-hua, Yang Yu-hui   

  1. Department of Rehabilitation, China-Japan Union Hospital of Jilin University, Changchun  130033, Jilin Province, China
  • Online:2010-08-27 Published:2010-08-27
  • Contact: Yang Yu-hui, Attending physician, Department of Rehabilitation, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China yangyuhuime@163.com
  • About author:Pang Ling★, Master, Nurse-in-charge, Department of Rehabilitation, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
  • Supported by:

    the Grant of Science and Technology Committee of Changchun City, No. 01-126S50*

PDF

321

被引次数

6

摘要：

背景：下肢深静脉血栓形成是全髋关节置换患者围手术期严重的并发症，其发生率较高。目前尚不清楚原发病对老年全髋关节置换后下肢深静脉血栓形成的影响。
目的：观察不同原发病对老年全髋关节置换后下肢深静脉血栓形成的影响。
方法：选择单侧全髋关节置换患者147例，年龄64~93岁，根据原发病不同分为2组：骨折组68例，置换前经历了创伤，均为股骨颈骨折患者；骨病组79例，术前未经历过创伤。根据患者生理年龄、置换前社会活动能力、骨质情况、预期寿命等选择全髋假体，其中采用生物学假体5例，混合型假体12例，其他全部采用骨水泥型假体。对术后出现患肢肿胀和/或疼痛，下肢伴有或不伴有Homans征/ Neuhofs征阳性的患者常规应用加压超声技术进行超声多谱勒检查。
结果与结论：骨折组置换后32例出现患侧肢体肿胀，伴有疼痛者20例，出现Homans征/ Neuhofs征15例，经超声多普勒检查证实29例下肢下肢深静脉血栓形成阳性；股骨颈骨折后行全髋关节置换1例，无下肢深静脉血栓形成临床症状，于置换后17 d猝死，尸检证实为伤侧下肢混合型下肢深静脉血栓形成合并肺栓塞；骨病组置换后20例出现患侧肢体肿胀，伴有疼痛者11例，出现Homans征/ Neuhofs征9例，经超声多普勒检查证实20例下肢深静脉血栓形成阳性。股骨颈骨折患者比骨病组患者具有更高的血液凝固状态，下肢深静脉血栓形成发生率更高(P < 0.05)。提示股骨颈骨折是老年全髋关节置换后下肢深静脉血栓形成发生的高危因素。

关键词: 原发病, 全髋关节置换, 深静脉血栓形成, 老年人, 人工假体

Abstract:

BACKGROUND: Deep vein thrombosis (DVT) of the lower limbs is one of the severe complications of total hip replacement (THR) during the perioperative period. The incidence rate was high. The effect of primary disease on the DVT after THR in the elderly remains poorly understood.
OBJECTIVE: To explore the effect of primary disease on DVT after THR in the elderly.
METHODS: 147 cases with unilateral THR aged 64-93 years, were included and divided into two groups. Fracture group contained 68 cases, which of them were all traumatic femoral neck fracture ones. Osteopathia group contained 79 cases, and they had no traumatic injury. We selected total hip prostheses according to their physiological age, preoperative socialization ability, substantia ossea and life expectancy. Biological prosthesis in 5 cases and mixed prosthesis in 12 cases were used, while the others used bone cement prosthesis. If the patient had pain and/or swelling on the injured limb, with or without Homans/Neuhofs sign, we did the pressurized ultrasonic Doppler to examine whether the patient had got DVT.
RESULTS AND CONCLUSION: In the fracture group, 32 cases had swelling in the injured limbs, and 20 cases with pain, 15 cases with Homans/Neuhofs sign, and 29 DVT cases were confirmed by the pressurized ultrasonic Doppler. One femoral neck fracture case of THR had no DVT clinical signs and was dead 17 days later. The autopsy found that it was an mixed type combined of pulmonary embolism; Osteopathia group: 20 cases had swelling in the injured limbs, and 11 cases of pain, 9 cases of Homans / Neuhofs sign, 20 DVT cases were confirmed by the pressurized ultrasonic Doppler. The blood coagulation state was greater, and the incidence rate of DVT in the lower limbs was greater in the fracture group compared with osteopathia group (P < 0.05). These indicated that femoral neck fracture is a high risk factor for DVT development in lower limb after THR in the elderly.

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