The Study Of Perioperative Prevention Strategies Of Deep Venous Thrombosis In Total Hip Arthroplasty

Objective:To investigate the perioperative deep vein thrombosis incidence of total hip arthroplasty in orthopaedics department of the First Affiliated Hospital of Zhejiang University School of Medicine, and to analysis related factors and recommend some strategies of perioperative deep vein thrombosis preventions and treatments based on the results and discuss the strategies effects.Method:To investigate the patients clinical data as retrospective study in orthopaedics department of the First Affiliated Hospital of Zhejiang University School of Medicine from January2011to February2013. Followed the historical information and treatment records, collect the relevant information, including basic information, the main admission diagnosis before surgery combined with deep vein thrombosis-related diseases, preoperative blood lipid levels, peri-operative coagulation tests, D-dimer, surgery, operative time, blood loss, anesthesia, perioperative prevention and treatment measures, lower extremity DVT formation and lower limbs deep venous ultrasound results. All clinical cases are accordant with the relevant project assignment for count data. The statistical analysis software is SPSS16.0.Results:The number of patients with total hip arthroplasty surgery is178in orthopaedics department of the First Affiliated Hospital of Zhejiang University School of Medicine from January2011to February2013. In the first year, there were146patients totally,70males and78females, aged42-87years old, mean age at (68.1±8.7) years old. The numbers of DVT positive patients who are confirmed by the deep venous ultrasound are2, the rate was2.3%, the otherwise clinical symptoms or perioperative D-dimer was increasing significantly without lower extremity deep vein color Doppler ultrasound examinations are33cases, with suspected DVT incidence of37.5%. In the second year, there were150patients totally,76male cases,74female cases, aged31-97years, mean age (71.3±9.4). The numbers of DVT positive patients who are confirmed by the deep venous ultrasound are0, the incidence of0%, the otherwise clinical symptoms or perioperative D-dimer was increasing significantly without lower extremity deep vein color Doppler ultrasound examinations are19with suspected DVT incidence of21.1%. As related factors, the occurrence of DVT is higher in the patients age>70years than other patients. The gender showed non-significant effect on the occurrence of DVT. The occurrence of DVT was higher in the patients who have femoral neck fractures than that in the patients with osteoarthritis and developed dysplasia hip. The occurrence of DVT was higher in the patients with pulmonary disorders, tumors and diabetes mellitus than others. The occurrence of DVT was lower in the patients with shorter operative duration (<2hours). The application of medicine to modulate the dynamics of blood did not affect the occurrence of DVT significantly. The patients who were in bed for a long preoperative time or had the D-dimer higher than500ug/L, or higher than the D-dimer values before significantly (the difference is over than50%of the preoperative), should be confirmed by deep vein ultrasound because of significant higher incidence of DVT. The occurrence of DVT was lower in the patients underwent application of low molecular weight heparin, rivaroxaban and dressing vein pumps.Conclutions:The high risk factors of DVT in the patients with total hip arthrosplasty included age)70years, accompanied with pulmonary disorders or diabetes mellitus. The application of medicine to modulate the dynamics of blood was non-significant to decrease the occurrence of DVT. The use of low molecular weight heparin, rivaroxaban and dressing vein pump, shorter operative time (<2hours) were effective to decrease the occurrence of DVT in the patients with total hip arthroplasty. The patients in bed for a long preoperative time with the D-dimer higher than500ug/L, or than the D-dimer values before surgery significantly (the difference is over than50%of the preoperative), whose the incidence of deep vein thrombosis are higher significantly which should be confirmed by deep vein ultrasound. It is showed that the treatments of low molecular weight heparin, Rivaroxaban or dressing vein pumps should be used for deep vein thrombosis preventions.