中国临床康复2005，Vol.9Issue(42)：164-166,3.
人工全髋关节置换术后下肢深静脉血栓形成原因的实验观察
Experimental study on the pathogenesis of deep venous thrombosis in lower limbs following artificial total hip replacement
摘要
Abstract
BACKGROUND:Deep venous thrombosis has already been recognized as an important serious postoperative complication because it can cause fatal pulmonary embolism and long-term deep venous dysfunction. With the constant development of artificial joint operation and the popularization of such surgery, much attention has been paid to the formation of deep venous thrombosis following artificial joint replacement.OBJECTIVE: To observe the anatomical property of acetabular surrounding arteries and veins, as well as their injury during total hip replacement,so as to explore the cause of deep venous thrombosis in lower limbs following artificial total hip replacement.DESIGN: Single sample observation and before-after self-control.SETTING: Gross anatomy was carried out in the anatomical laboratory of the Medical School of Huzhou Teachers' College; total hip replacement was carried out in the Orthopedic Department, Xinhua Hospital of Zhejiang Traditional Chinese Medicine College.PARTICIPANTS: Pelvic samples were collected from 60 normal adult corpuses (30 from men and 30 from women); meanwhile, 30 patients (18 males and 12 females) received total hip replacement in the Orthopedic Department of Xinhua Hospital, Zhejiang Traditional Chinese Medicine College, between March 2002 and August 2003.METHODS: Gross anatomy was carried out at the anatomical laboratory in the Medical School of Huzhou Teachers' College between March and May 2003. The running course of bilateral external iliac artery and vein, as well as the relationship between the branches of femoral artery and vein and acetabulum were observed on 60 pelvic samples. In order to make the observation easier, 12 o'clock division mode chart of acetabulum was established, that is, a line drawn from anterior superior iliac spine toanterior inferior iliac spine, with the crossing point of its extension line and acetabular edge taken as 12 o'clock, therefore the other points should be arranged clockwise. Totally 30 patients received artificial total hip replacement by acetabular lateral-posterior approach. One week later, bilateral deep venous radiography was performed to observe the state of deep venous thrombosis in lower limbs.MAIN OUTCOME MEASURES: ① The anatomical relationship between the branches of external iliac artery and vein, femoral artery and vein and acetabulum. ② The formation rate of deep venous thrombosis in lower limbs after total hip replacement. ③ Adverse events and side effects.RESULTS: Totally 60 adult normal pelvic samples and other 30 pelvic samples of patients who received total hip replacement remained in the results analysis. ① Anatomical observation of external iliac artery and vein,as well as femoral artery and vein: the branches of femoral artery and vein: Medial and lateral circumflex femoral arteries were found running across acetabulum and entering acetabulum; the safe position for the retractor was from 12 o'clock to 3 o'clock and from 5 o'clock to 9 o'clock. However, 9o'clock to12 o'clock and 3 o'clock to 5 o'clock were taken as fragile regions. ② The incidence of deep venous thrombosis following total hip replacement: Bilateral deep venous radiography was carried out after operation and revealed that 11 patients developed deep venous thrombosis with the incidence of 37%. ③ Adverse events and side effects: Postoperative bleeding of over 1 000 mL occurred in 3 cases. In order to fully expose operative field, the retractor should be used to hold off muscles and other tissues, which contributed to long-term vascular compression and blood flow retardation.CONCLUSION: Artificial total hip replacement is liable to injure the internal wall of acetabular vessels, thereby leading to blood flow retardation and platelet aggregation, and ultimately thrombosis. In addition, the massive bleeding during operation will increase blood mucosity, which also increases the risk for thrombosis. From the mode chart of fragile regions and safe regions, we can deduce that deep venous thrombosis in lower limbs can be reduced.关键词
关节成形术,置换,髋/静脉血栓形成/解剖学分类
医药卫生引用本文复制引用
杨景武,史晓林..人工全髋关节置换术后下肢深静脉血栓形成原因的实验观察[J].中国临床康复,2005,9(42):164-166,3.基金项目
浙江省教育厅科研课题(20040788) （20040788）
