Hematology Detection Of Lower Limb Deep Vein Thrombosis And Analyze Of Risk Factors After Total Joint Arthroplasty

BACKGROUND：In the21st century, our country has gradually stepped into an agingsociety. By2020, China’s aging population will reach248million, aging level is17.17%. At the same time, the number of degenerative arthrosis also increases, and thenumber of artificial joint replacement increased year after year. Studies have shownthat, only the United States a year of knee replacement number more than400,000cases, by2030is expected to exceed2million cases.However, deep vein thrombosis(DVT) is a common complication after artificialjoint replacement, because that can lead to fatal pulmonary embolism, the clinicianspaid more and more attention. Current clinical mainly uses the D-dimer to reflect theblood coagulation and thrombosis after joint replacement, but because some problemssuch as false positives, false negatives and different detection methods can lead to different result, clinical significance is poor. In order to find out more specific, moresensitive index, or find a few indicators composite diagnostic strategy, we uses thecolor doppler ultrasound blood flow detector dynamically observe148patients withjoint replacement perioperative DVT, and use immune turbidimetry and enzyme-linkedimmunosorbent (ELISA) examined plasma D-dimer(DD), Fibrinogen(FIB), Fibrindegradation product(FDP), Thrombus precursor protein(TpP), Prothrombin fragment1+2(F1+2) and Thrombin-antithrombin(TAT) levels. Combine hematology indexes withthe ultrasound results, analysis of various index for the diagnosis of DVT sensitivityspecificity and diagnostic value of each index. In order to define what is jointreplacement patients risk factor of DVT, We divided the patients into DVT positive andnegative groups, analyze the relationship of medical history, physical sign and relatedclinical factors with the occurrence of DVT, determine what is a risk factor for DVTafter artificial joint replacement. Provide guidance for clinical doctors to found whichpatient has high risk of DVT in a timely, and strive to achieve early detection, earlydiagnosis, early treatment, to minimum the harm of DVT.1. Hematology detection deep vein thrombosis of lower limb after artificialjoint replacementOBJECTIVE Exploring hematology indexes to early diagnosis of deep veinthrombosis of lower limbs after artificial joint replacement. METHODS Form June2011to June2012, the plasma D-dimer, Fibrinogen, Fibrin degradation product,Thrombus precursor protein, Prothrombin fragment1+2and Thrombin-antithrombinlevels was examined for62cases undergoing total knee arthroplastic(TKA),82casesundergoing total hip arthroplastic(THA)，4cases undergoing total anklearthroplastic(TAA) before operation and1,3,7days after operation. Color dropplersonography and hemorheology detection were also carried out for these patients beforeoperation and3,7days after operation. After operation, all the patients were treated with the regular Rivaroxaban against DVT. According to the ultrasound results dividedthe patients into DVT positive group and DVT negative group, Using thereceiver-operating characteristic curve analysis to assess the diagnostic value of theabove indicators for DVT, respectively to study the sensitivity and specificity of eachtarget. RESULTS After operation,44cases(29.7%) developed DVT. Inimmunoturbidimetry results, the AUCs were79.8%for DD,67.9%for FDP(P＜0.05),and for FIB the AUCs were57%but P＞0.05. In ELISA results, the AUCs werefor DD, TpP, TAT, were87.5%,72.3%and78.3%respectively(P＜0.05). But forF1+2,P value is0.09. CONCLUSIONS DD, TpP, TAT and FDP are sensitive indexesto evaluate DVT. The diagnostic values of D-dimer is higher, and the ELISA methodfor detection D-dimer has better diagnostic value.2. Analyze risk factors of deep vein thrombosis after total jointarthroplasty.Objective Analysis and explore risk factors of deep vein thrombosis(DVT) aftertotal joint arthroplasty. Methods Form June2011to June2012, color dropplersonography detection were carried out for148patients undergoing total jointarthroplasty, before operation and3,7days after operation. The patients was dividedinto DVT and DVT-free groups based on the development of DVT after operation.Detailed perioperative clinical information about the patients was collected. Clinicalfactors were examined perioperatively in order to analyze their influences on DVTformation after surgery. Results After operation,44cases(29.7%) developed DVT.Logistic regression analysis indicated that patients older than65, general anesthesiaand TKA were the risk factors for the occurrence for DVT after total jointarthroplasty(P＜0.05). Conclusions Old age, obesity, general anesthesia, TKA, werethe risk factors for the occurrence for DVT after total joint arthroplasty. Cliniciansshould pay attention to it.