| Objective：Deep vein thrombosis is a common disease after total kneearthroplasty.It is reported that the DVT occurrence can be40%-84%if nonepreventive measures been done.The thrombosis is most probably formed in thecalf muscular vein first.However,there are few symptoms andsigns.Venography is considered the gold standard for DVT diagnosis,but it’sexpensive and invasive,not fit to be repeated.At the same time,B-ultrasonography is widely used in clinical work for DVT diagnosis,it’sconvenient and efficient. but there are also differences between the fibrinolyticindividual.Meanwhile, the inconspicuous operator skill or the facility itself hasan impact on the postoperative treatment. The Plasma D-dimer measurementis commonly used in perioperative period as one of the postoperativemonitoring indicator for lower extremity deep vein thrombosis.The researchesindicate that the D-dimer is cracked by plasmin and one of the crosslinkedfibrin degradation products,is helpful to the diagnosis of lower extremity deepvein thrombosis.It is reported that the relationship between the D-dimer leveland thrombosis reflect the function of the plasmin.The D-dimer level isrelative to result of ultrasonic examination of lower extremity deep venousthrombosis patients. Owning to the concealment of calf muscular venousthrombosis, few researches are on patients of the calf muscular venousthrombosis and those of the D-dimer level change of none-thrombosis afterTKA. We observe the patients who take the low molecular heparin calcium asanticoagulant treatment, and do the system analysis of the relativity betweenD-dimer level and B-ultrasonography after TKA.Methods:2012January to2012October in our department underwentunilateral TKA total of189patients as the observation object, take the kneejoint anterior median incision of knee joint in front of the skin, the medial parapatellar approach incision capsular exposure of knee joint bone repairingpatella, patellar denervation, no patellar replacement, femoral and tibialarticular surface replacement to take knee replacement standard operationtechnique, use the antibiotice bone cement prosthesis, after the installation ofrelaxing tourniquet and careful hemostasis, the intraoperative tourniquet timeis20-45minutes, average33.2minutes.Take the low molecular heparincalcium in0.4ml (4100u) by postoperative subcutaneous injection foranticoagulant treatment once a day. Take the low molecular heparin calcium in0.1ml/10kg twice a day when we found the thrombus.. All patients take theexamination of lower limbs deep vein B-ultrasound and plasma D-dimer in thefirst day, second days, fifth days, eighth days and eleventh days. By Bultrasound examination were divided into thrombus group and no thrombusgroup, analyzes its two D-dimer changes. For the patients with venous plexusthrombosis of the calf muscle, analysis of calf muscular venous thrombosisand D-dimer changes. Using the Mann-Whitney U test to compare thethrombus group and none-thrombus group at the different time were measuredby D-dimer value difference. Combined the D-dimer from the thrombosisgroup patients when they were detected to the DVT in second,5th and8th dayafter operation with the D-dimer from the none-thrombus group patient at thecorresponding time to protract the ROC curve.Results:189cases of this group underwent unilateral TKA surgery,including38males and151cases of female patients with the youngest patientswas51years old, and the oldest patients was79years old, with an average ageof62.78±7.03years. Postoperative examination were65cases of deepvenous thrombosis in patients, the proportion was34.4%, male10, female55cases, with an average age of63.85±7.08years (range47-78years). Thesecond day after operation occurred in DVT24cases, DVT23cases,accounting for36.9%; fifth days after operation accounted for35.4%; DVT18cases occurred eighth days after operation, accounting for27.7%. The patientsin the none-thrombus group were124cases, male28cases, female96cases,mean age62.22±6.96years old (51-79years old). There were two peaks of the postoperative D-dimer after first day adnfifth day in the thrombus group and none-thrombus group. In thrombus group,the D-dimer level had first peaks at the first postoperative day and,the medianwas4.19mg/L, the four quartile range was (3.55-4.80) mg/L. The D-dimerdecreased significantly in the second day after operation and reaching thesecond peak at fifth day after operation, the median was1.30mg/L, the fourpercentile range was (1.20-1.43)mg/L. In none-thrombus group the D-dimerlevel had first peaks at the first postoperative day and,the median was3.97mg/L, the four quartile range was (3.48-4.68) mg/L. The D-dimerdecreased significantly in the second day after operation and reaching thesecond peak at fifth day after operation, the median was1.15mg/L, the fourpercentile range was (1.07-1.24)mg/L. Compare the D-dimer in each timebetween thrombus group and none-thrombus group, the D-dimer of thrombusgroup was higher than the none-thrombus group at the second5th8th11th dayafter operation, the difference was statistically significant (P＜0.05). TheD-dimer of thrombus group was higher than the none-thrombus group at thefirst day after operation after operation, the difference was no significant.(P＞0.05).According to the ROC curve protracted by the D-dimer between thethrombus group and the none-thrombous group patient after operation at thecorresponding time, we can obtain the truncation point is0.86mg/L at secondday after operation, the sensitivity and specificity were75%and69.4%. Thetruncation point is0.86mg/L at5th day after operation, the sensitivity andspecificity were69.2%and88.7%. The truncation point is1.25mg/L at8thday after operation, the sensitivity and specificity were62.5%and96.8%. Thearea under the cruve of ROC curve were0.709,0.726,0.854at second5th and8th after operation.Conclusion:(1)Postoperative2-5days is the period of high incidence ofDVT after TKA.(2)The the D-dimer value has two summits after TKA.(3) TheD-dimer measurement can increase the accuracy of DVT diagnosis after TKA.Taking early examination of B-ultrasonography and the D-dimer measurement,we can have systematic and regular guidance. When theD-dimer of patients was higher than0.86mg/L at second day after TKA, evenin the patients were without obvious clinical symptoms, we can also extremelysuspect the patient had the possibility of DVT, The D-dimer was lower1.30mg/L and1.25mg/L at5th and8th days after operation, we could basicallyrule out the possibility of lower extremity DVT. |
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