| Objective: Deep venous thrombosis(DVT)is a common complication in major orthopedic surgery,especially total hip replacement and total knee replacement.The postoperative lower extremity DVT occurrence rate can reach 40%~60% without any preventive measures,seriously affect the prognosis and safety of patients.some viewpoints think compared with Europe and the United States race,Asian race is less prone to get venous thrombosis,postoperative thrombosis did not get enough attention from the surgeon in a long time.2003 July AIDA research results showed that Asia including China major orthopedic surgery patients’ DVT occurrence is close to the rate of the western countries,in the past 10 years with the artificial joint replacement surgery amount increase and technique improve,more and more Chinese orthopedic specialists for clinical research confirms this view.Due to the prevention of DVT in China started late,lack of recognition of the diagnosis and treatment of DVT,clinicians’ attention degree is different,prevention methods is variety,An epidemiological survey of the prevalence of venous thromboembolism in the national ICU/CCU(RAMP survey)showed that the ratio of using the guidelines recommend measures for thromboprophylaxis now in our nation is only about 20% and the reported effect after prevention is differ greatly.Our study retrospective investigate the Third Hospital of Hebei Medical University lower extremity deep venous thrombosis(DVT)incidence after arthroplasty,to explore the effect of application of low molecular weight heparin calium and Different time foot pump to prevent the formation of DVT.Methods: Select the Third Hospital of Hebei Medical University from 2012 July-2014 January admitted patients with artificial joint replacement,male 664 cases,female 403 cases,aged 18-89 years old,average(52.5±13.2)years,including 1035 cases of total hip arthroplasty,left hip 442 cases,right hip 424 cases,double hip 169 cases;32 cases of total knee arthroplasty,left knee 17 cases,right knee 12 cases,double knee 3 cases.Low molecular weight heparin in 1011 patients,56 cases of only ankle pump during the same period as control.1067 patients applicate different time ankle pump preventive measures after surgery,divided into four groups: Every 5/10/15/20 minutes flex and extense ankle once.Collect patients’ basic information,admission diagnosis,whether combined with DVT formation related diseases,joint replacement cause,surgery type,anesthesia type,surgery time,bleeding amount,foot-ankle pump interval time,lower extremity DVT deep venous ultrasound and phlebography results.all the information to the count data,use statistical software SPSS13.0 analysis the risk factors for occurrence of DVT and effects of preventive measures for DVT,and compared with the epidemiological data of the 2002 seven Asian countries 19 orthopaedic centers lower limb DVT formation after artificial joint replacement,analyse the protective effect of this measure on the incidence of DVT after artificial joint replacement.Results : The double lower extremity deep venous color Doppler ultrasonography diagnosis of DVT formation 87 cases,phlebography diagnosis 16 cases,total 103 cases,the incidence rate is 9.65%.Female,old,diabetes,trauma,knee replacement,long time surgery,bleeding amount during operation large,foot-ankle pump interval time long and non anti clotting drugs have significant effect on the incidence of postoperative lower limb DVT.The incidence of DVT in female patients was 16.1%,male patients were 5.7%,male patient’s DVT occurrence risk was famle’s 31.6%;the incidence of DVT in patients under 40 years old was 3.1%,40-60 years old was 10.4%,60 years old and above was 12.1%,40 years old patients DVT occurrence risk was 40-60 years old patients’ 27%,60 years old and above’s 23.6%;the incidence of DVT in diabetes patients was 20.8%,non diabetic patients was 9.1%,non diabetic patients’ DVT occurrence risk was diabetic patients’ 38.1%;the incidence of DVT in trauma patients was 29.9%,non trauma patients was 3.1%,non trauma patients’ DVT occurrence risk was trauma patients’ 7.5%;the incidence of DVT in THR patients was 9.1%,TKR patients was 38.1%,THR patients’ DVT occurrence risk was TKR patients’ 25.5%;the incidence of DVT in operation time less than 45 minutes patients was 7.3%,more than 45 minutes patients was 11.3%,operation time less than 45 minutes patients’ DVT occurrence risk was operation time more than 45 minutes patients’ 61.7%,the incidence of DVT in intraoperative bleeding amount less than 800 ml patients was 4.9%,more than 800 ml patients was 13.3%,intraoperative bleeding amount less than 800 ml patients’ DVT occurrence risk was intraoperative bleeding amount more than 800 ml patients’ 35.6%;the incidence of DVT in foot-ankle pumps time interval of 5 minutes group patients was 4.8%,10 minutes group patients was 6.3%,15 minutes group patients were 11.6%,20 minutes group patients were 14.1%.10 minutes group patients’ DVT occurrence risk was 15 minutes group patients’ 51.4%,20 minutes group patients’ 41.0%.the incidence of DVT in patients with low molecular weight heparin was 8.5%,no low molecular weight heparin was 30.4%,the occurrence risk of DVT in patients with low molecular weight heparin was 21.3% of patients without low molecular weight heparin.Side,bedrest time,hypertension,coronary heart disease,type of anesthesia and postoperation bleeding amount have no significant effect on the incidence of postoperative lower limb DVT.The preventive measures taken by this study make the incidence of postoperative DVT decreased obviously,comparison with the formation of lower extremity DVT in 2002 seven Asian countries 19 orthopedic centers after artificial joint replacement,the preventive measures taken by this study make DVT risk reduced to its 16.1%.Conclusions : The Third Hospital of Hebei Medical University after arthroplasty,using low molecular weight heparin calium and foot pump prevention,lower extremity DVT incidence was 9.65%,less than the reported of which is not prevention at home and abroad.Female,old,diabetes,trauma,knee replacement,long time surgery,bleeding amount during operation large,foot-ankle pump interval time long and non anti clotting drugs have significant effect on the incidence of postoperative lower limb DVT,while Side,bedrest time,hypertension,coronary heart disease,type of anesthesia and postoperation bleeding amount have may have some effect on the incidence of postoperative lower limb DVT,but there was no significant difference in this study,considered due to the intervention of preventive measures and lack of the cases.Consider the best foot-ankle pump interval time is 10 minutes. |
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