Abstract:Objective The incidence of symptomatic venous thrombo embolism(VTE) after knee arthroscopy is uncertain.To determine the incidence,anatomical distribution of venous thrombo embolism(VTE) in limbs undergoing elective unilateral knee arthroscopy without active pharmacologic prophylaxis,to quantify the impact of risk factors on its incidence,and to evaluate the necessity of active pharmacologic prophylaxis in patients undergoing arthroscopic surgery. Methods A retrospective cohort study of elective arthroscopic knee procedures during a twelve-month period(January 1,2015 to December 31,2015) was performed in our department of orthopedics.There were 400 patients who had elective arthroscopic knee procedures.270 were male,and 130 were female,with a mean age of(38 ± 15.2) years.The mean duration of the operation was(55 ± 21) minutes.The patients undergoing elective knee arthroscopy received general physical prophylaxis,but did not receive any kind of chemoprophylaxis.During 6 weeks post surgery,all patients having arthroscopy in our institution were routinely examined.Clinical signs of VTE were checked and recorded,and the occurrence of symptomatic deep venous thrombosis(DVT) or pulmonary embolism(PE) within 6 weeks after surgery was identified by duplex ultrasonography or pulmonary arteriography.The general risk factors of VTE were also analyzed.Results During 6 weeks post surgery,symptomatic DVT was detected in 4(1%) patients.Of these,1 was proximal,and 3 were distal.No patient died and no patient presented with clinically suspected PE.The risk of VTE was significantly higher among patients who had a tourniquet applied for more than 60 minutes or older than 60 years.Conclusion The incidence of symptomatic VTE after arthroscopic knee surgery is very low.Routine pharmacological prophylaxis to prevent symptomatic venous thromboembolism is likely not needed in this patient population.Older age and operation time are associated with increased risk.A specific highrisk group for the development of VTE should be identified and received effective prophylaxis.
姬振伟,徐奎,吴鹏,王志学,丁勇 *. 膝关节镜术后VTE的发生率及其抗凝策略分析[J]. 实用骨科杂志, 2018, 24(8): 696-700.
Ji Zhenwei,Xu Kui,Wu Peng,et al. Incidence of Venous Thrombo Embolism(VTE) in Elective Knee Arthroscopy and an Analysis about Its Prophylaxis. sygkzz, 2018, 24(8): 696-700.
[1]中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志,2016,36(2):65-71.
[2]Jaureguito JW,Greenwald AE,Wilcox JF,et al.The incidence of deep venous thrombosis after arthroscopic knee surgery[J].Am J Sports Med,1999,27(6):707-710.
[3]Maletis GB,Inacio MC,Reynolds S,et al.Incidence of symptomatic venous thromboembolism after elective knee arthroscopy[J].J Bone Joint Surg(Am),2012,94(8):714-720.
[4]Krych AJ,Sousa PL,Morgan JA,et al.Incidence and risk factor analysis of symptomatic venous thromboembolism after knee arthroscopy[J].Arthroscopy,2015,31(11):2112-2118.
[5]Janssen RP,Sala HA.Fatal pulmonary embolism after anterior cruciate ligament reconstruction[J].Am J Sports Med,2007,35(6):1000-1002.
[6]Graham WC,Flanigan DC.Venous thromboembolism following arthroscopic knee surgery:a current concepts review of incidence,prophylaxis,and preoperative risk assessment[J].Sports Med,2014,44(3):331-343.
[7]Ilahi OA,Reddy J,Ahmad I.Deep venous thrombosis after knee arthroscopy:a metaanalysis[J].Arthroscopy,2005,21(6):727-730.
[8]Caprini JA.Risk assessment as a guide for the prevention of the many faces of venous thromboembolism[J].Am J Surg,2010,199(1 Suppl):3-10.
[9]Demers C,Marcoux S,Ginsberg JS,et al.Incidence of venographically proved deep vein thrombosis after knee arthroscopy[J].Arch Intern Med,1998,158(1):47-50.
[10]Delis KT,Hunt N,Strachan RK,et al.Incidence,natural history and risk factors of deep vein thrombosis in elective kneearthroscopy[J].Thromb Haemost,2001,86(3):817-821.
[11]Ramos J,Perrotta C,Badariotti G,et al.Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy[J].Cochrane Database Syst Rev,2007(2):CD005259.
[12]Hull RD.Thromboprophylaxis in knee arthroscopy patients:revisiting values and preferences[J].Ann Intern Med,2008,149(2):137-139.
[13]Allum R.Complications of arthroscopy of the knee[J].J Bone Joint Surg(Br),2002,84(7):937-945.
[14]Sherman OH,Fox JM,Snyder SJ,et al.Arthroscopy “no-problem surgery”:An analysis of complications in two thousand six hundred and forty cases[J].J Bone Joint Surg(Am),1986,68(2):256-265.
[15]Wirth T,Schneider B,Misselwitz F,et al.Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin(reviparin):Results of a randomized controlled trial[J].Arthroscopy,2001,17(4):393-399.
[16]Michot M,Conen D,Holtz D,et al.Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery:A randomized trial of prophylaxis with low--molecular weight heparin[J].Arthroscopy,2002,18(3):257-263.
[17]Lachiewicz PF.Comparison of ACCP and AAOS guidelines for VTE prophylaxis after total hip and total knee arthroplasty[J].Orthopedics,2009,32(12 Suppl):74-78.
[18]Geerts WH,Bergqvist D,Pineo GF,et al.Prevention of venous thromboembolism:American College of Chest Physicians EvidenceBased Clinical Practice Guidelines(8th Edition) [J].Chest,2008,133(6 Suppl):381-453
[19]Falck-Ytter Y,Francis CW,Johanson NA,et al.Prevention of VTE in orthopedic surgery patients:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians EvidenceBased Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):278-325.
[20]Struijk-Mulder MC,Ettema HB,Verheyen CC,et al.Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery[J].J Thromb Haemost,2010,8(4):678-683.
[21]Kessler P.Venous thromboembolism prophylaxis in orthopaedics and traumatology[J].Vnitr Lek,2009,55(3):204-210.