The Significance Of Monitoring D-Dimer To Diagnosis The Lower Extremity Deep Vein Thrombosis After The Arthroscopic Surgery

Objective:D-dimer for a specific process of fibrinolytic markers, when the body inside the fiber dissolving activity or activation of thrombosis, D-dimer concentration will rise.Surgery, The tumor, PE and DVT, DIC, Infection,Tissue necrosis leads to elevated concentrations of D-dimer. Knee osteoarthritis is caused by knee joint cartilage degeneration and bone hyperplasia,a chronic joint disease, also known as proliferative arthritis of knee joint and osseous arthritis,degenerative arthritis, etc. Current treatments including non-surgical treatment and surgical treatment,non-operative therapy including oral non-seteroidal analgesics, glucosamine, articular cavity injection of sodium hyaluronate,etc.Surgical treatment including arthroscopic probe and knee arthroplasties.The arthroscopic probe and clearing operations is a new technology used in the diagnosis and treatment of knee joint disease is safe, but there is still associated with the risk of deep vein thrombosis of lower limbs.The formation of lower extre- mity deep vein thrombosis also known as lower extremity deep vein thrombosis, is middle-aged and old common peripheral vascular disease, refers to the lower extremity deep venous blood tube venous blood coagulation.Can lead to life-threatening, the disease has been deeply attention in clinic.Early and accurate diagnosis of lower extremity deep vein thrombosis is very necessary.Currently accepted lower extremity deep vein thrombosis diagnostic gold standard is lower extremity deep vein angiography, But for check with trauma,and requires high technology and equipment requirements, allergic to iodine contrast agent is taboo, at the same time patients with handling process could fall off the blood clots and cause the risk of pulmonary embolism, so looking for a simple, quick and noninvasive diagnostic method is particularly important.D-dimer currently has been widely used in clinical thrombosis forecast,but After the knee arthroscopy surgery D-dimer concentration and Observation time is not clear.To discuss the relationship between after the arthroscopic surgery formed a deep vein thrombosis of lower limbs and the D-dimer concentration increased.Further provide the basis for the clinical prevention of lower extremity deep vein thrombosis.Methods:According to the inclusion criteria,selection of 2011.07 to 2014.10 in the first hospital of baoding city line the arthroscopic treatment of patients were retrospectively study.According to the postoperative patients with lower limb vascular ultrasound examination results will be divided into thrombus group and not the thrombus group.A total of 30 patients with concurrent thrombosis, including 12 cases male and 18 female, mean age, 51.17 years;Never happened thrombosis patients ages, body conditions close to concurrent thrombosis in patients with 30 cases as control group of patients.including 11 cases male and 19 female, mean age, 51.40 years.All patients in preoperative 1 day to do the double lower limb vascular ultrasound,except for lower extremity deep vein thrombosis.Detection venous blood concentration D-dimer.Operation method: All of the patients using the waist hard joint anesthesia downlink operation.Preoperative the thigh root put a tourniquet, set 45 kpa pressure, time of 60 minutes.In natur- al lowered state of knee,With a 20 ml syringe from the medial or lateral joint clearance piercing into the joint cavity. Suction articular cavity accumulates fluid flowing outward, Filling 20 ml saline injection to articular cavity.Select the outside entrance of the knee joint,use a sharp knife cut open joint capsule,Insert blunt puncture outfit and lens,Mirror set respectively connected to the water pipe and the outlet pipe on both sides of the interface,in order to have a targeted for lavage for replacement.Slowly under arthroscopy monitoring knee flexed movement, to check the knee joint.The same method, do knee joint medial entrance,The planing tool or condensation knife inserted into the knee joint, in the joints do loose bodies take out,the meniscus forming and chondroplasty.The microscopic surgery was completed, inspect the joint cavity,rinse the articular cavity, pull out lens.The operation time at 28-60 minutes, average in 39.6 minutes. The lavage fluid use are 5000 ml to 8000 ml,average of 6600 ml.12 hours after the application of low molecular heparin calcium 0.4 ml(4100 iu) anticoagulant treatment once a day,at the injection site selection subcutaneous abdominal wall.To guide the limb functional exercise,raise the diseased side limb,activities on the ground.Postoperative 1, 2, 3, 5, 8 days lines of double lower limb vascular ultrasound examination to determine whether have the lower extremities deep venous thrombosis.And on the same day detection venous blood concentration D-dimer.Organize and analysis D-dimer concentration values.Results:1. Postoperatively in thrombosis and no thrombosis patients, group D- dimer at each time point concentration were higher than preoperative. In no thrombus group D-dimer concentration Peak appeared in 2 to 3 days,Then gradually reduce.Thrombus group D-dimer concentration Peak appeared in 2 day then gradually reduce.Each time point of the thrombus group of patients after surgery D-dimer concentration significantly higher than the no thrombus group at the same time.Comparative differences between groups with statistical significance(P < 0.05).2. In thrombus group postoperative day 1 D-dimer levels for(2507 + /- 869.4475)ng/ml occurred thrombosis patients, 5 cases(16.7%), after 2 days D-dimer concentration of(3086 + /- 679.8712)ng/ml occurred thrombosis patients, 9 cases(30%), after 3 days D-dimer3. concentration of(3422 + /- 308.8399)ng/ml occurred thrombosis patients, 14 cases(46.7%),after 5 days of D-dimer concentration for(3288 + /- 578.2697)n g/ml, 2 cases(7.3%), after 8 days of D-dimer concentration for(2792 + /- 741.6016)ng/ml no thrombosis cases.4. Detecting thrombus in 30 cases of patients with postoperative lower limb deep vein thrombosis occurs D dimer concentration as shown in FIG. 3.According to the thrombosis 95 % range of D-dimer concentration the calculation results of 3114 ng/ml.Conclusion:1. After the arthroscopic surgery, patients with thrombosis and no thrombosis group D- dimer in venous blood were increased, but thrombosis group higher degree is more higher than the no thrombus group.2. After the arthroscopic surgery, regular testing in patients with peripheral venous blood of D- dimer, when D- dimer in patients with peripheral venous blood concentration higher than 3114 ng/ml, should be combined with the patient’s clinical symptoms, decide whether line of ultrasound in the diagnosis of lower limb DVT of lower extremities.3. After the arthroscopic surgery, should according to patients’ clinical symptom,testing in patients with peripheral venous blood of D-dimer when D- dimer in patients with peripheral venous blood concentration higher than 3114 ng/ml, should further lines of ultrasound examination judgment of lower limb DVT formation of lower limbs.