关节置换术后下肢深静脉血栓形成的解剖分布

目的 探讨初次全膝关节置换术和全髋关节置换术后下肢深静脉血栓形成的解剖分布特点.方法 回顾性分析2007年6月至2012年5月接受初次全膝关节置换术或全髋关节置换术后经下肢静脉造影诊断为下肢深静脉血栓形成的272例患者的病例资料,全膝关节置换组110例,全髋关节置换组162例.观察静脉造影中两种术式术后下肢深静脉血栓形成的部位及其差异.结果 全膝关节置换组中,中心型血栓10例、周围型血栓94例、混合型血栓6例；全髋关节置换术组中,中心型血栓3例、周围型血栓140例、混合型血栓19例.两组血栓类型的差异有统计学意义(x2=9.996,P=0.007).全膝关节置换术和全髋关节置换术后血栓最易累及部位依次为肌间静脉193例(71.0％,193/272)、胫后静脉98例(36.0％,98/272)、腓静脉85例(31.3％,85/272)、胫前静脉24例(8.8％,24/272)、腘静脉24例(8.8％,24/272)、髂股静脉20例(7.4％,20/272).周围型血栓中,全膝关节置换组比全髋关节置换组更容易累及多支静脉,两组差异有统计学意义(x2=14.712,P=0.000).在孤立性血栓中,无胫前静脉血栓形成.在多支静脉血栓中,两组均以累及胫后静脉、腓静脉、肌间静脉血栓中的两支或三支常见.结论 全膝关节置换术和全髋关节置换术后下肢深静脉血栓形成的解剖分布不同.

The anatomical distribution of lower extremity deep vein thrombosis after total knee and hip arthroplasty

Objective To analyze the anatomical distribution of lower extremity deep vein thrombosis (DVT) after primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods Data of 272 patients with lower extremity DVT confirmed by venography after TKA and THA performed from June 2007 to May 2012 in our hospital were retrospectively analyzed. There were 110 cases in TKA group and 162 cases in THA group. The anatomical distribution of lower extremity DVT after TKA and THA was analyzed and compared. Results In TKA group, there were 10 cases of central DVT, 6 cases of mixed DVT, and 94 cases of peripheral DVT. In THA group, there were 3 cases of central DVT, 19 cases of mixed DVT, and 140 cases of peripheral DVT. There was a significant difference between two groups in the distribution of DVT. In all DVT patients, intramuscular veins were involved most frequently (71.0%, 193/272), followed by posterior tibial veins (36.0%, 98/272), peroneal veins (31.3%, 85/272), anterior tibial veins (8.8%, 24/272), popliteal veins (8.8%, 24/272), and iliofemoral veins (7.4%, 20/272). For patients with peripheral DVT, the isolated DVT was more frequent in THA group, while multiple DVT was more common in TKA group, and the differences were significant between two groups. No isolated DVT was found in anterior tibial veins. In patients with multiple DVT, the thrombi were commonly found in two or three of posterior tibial veins, peroneal veins and intramuscular veins. Conclusion There is a significant difference in the anatomical distribution of DVT after TKA and THA.