髋关节置换术围手术期的深静脉血栓预防策略的研究
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摘要
目的：
调查研究浙江大学医学院附属第一医院骨科2011年至2013年行人工髋关节置换术的患者在围手术期下肢深静脉血栓的发生率,统计分析其相关影响因素,根据研究结果制定出围手术期的深静脉血栓预防治疗策略,并讨论分析其预防及治疗效果。
方法：
回顾性调查浙江大学医学院附属第一医院骨科从2011年1月至2013年2月行人工髋关节置换术的患者临床资料,根据其相关病史治疗记录,收集整理数据资料,包括患者的基本信息、入院主要诊断、入院合并症、血脂水平、凝血功能、D-二聚体水平、手术方式、手术时间、术中出血量、麻醉方式、围手术期预防治疗措施、下肢深静脉超声检查的结果等。各项病历资料根据相关研究赋值统计,统计软件使用SPSS16.0统计分析。
结果：
浙江大学医学院附属第一医院骨科从2011年1月至2013年2月行人工髋关节置换术的患者共计178例,男性86例,女性92例,年龄介于31-97岁,平均年龄(69.6±9.2)岁。第一年(从2011年1月至2011年12月),共计患者88例,男性40例,女性48例,年龄42-87岁,平均年龄(68.1±8.7)岁,经下肢深静脉超声检查确诊深静脉血栓的患者,即DVT显性患者为2例,发生率为2.3%；此外,有临床症状或围手术期D-二聚体明显升高但未经下肢深静脉超声检查的患者有33例,即隐性DVT患者有37.5%。第二年(2012年1月至2013年2月),共计患者90例,男性46例,女性44例,年龄31-97岁,平均年龄(71.3±9.4)岁,经下肢深静脉超声检查确诊下肢DVT形成(DVT显性患者)0例,发生率为0%,有临床症状或围手术期D-二聚体明显升高但未经下肢深静脉彩超检查的患者有19例,即隐性DVT发生率为21.1%。深静脉血栓发生的相关影响因素分析结果如下：年龄在70岁以上的患者较其他年龄段的患者深静脉血栓发生率明显上升；性别对深静脉血栓发生的影响不显著；入院主诊断为股骨颈骨折而接受人工全髋关节置换术的患者,较其他诊断如股骨头坏死或髋关节发育不良而接受人工全髋关节置换术的患者深静脉血栓发生率更高；术前合并有肺部疾病、肿瘤、糖尿病的患者围手术期深静脉血栓的发生率增加；手术时间超过2小时的患者深静脉血栓发生率增高；术前应用活血药物的患者其围手术期DVT的发生率无显著下降,术后应用规范的药物及物理抗凝治疗,如低分子肝素注射、利伐沙班口服抗凝治疗、下肢静脉泵等的患者深静脉血栓发生率降低；术前卧床休息的时间超过2周的患者发生深静脉血栓的概率增大；术前D-二聚体水平大于500ug/L,术后D-二聚体值比术前明显升高(差值大于术前50%)的患者,发生深静脉血栓的风险明显增大,尤其是伴有下肢肿胀等疑似深静脉血栓发生的临床表现患者,应进一步使用深静脉超声检查予以明确诊断治疗。
结论：
在接受人工全髋关节置换术的患者中,年龄段大于70岁且术前合并有糖尿病、肿瘤、肺部疾病的患者更容易发生深静脉血栓；术前应用活血药物不能显著降低深静脉血栓的发生率；围手术期规范应用低分子肝素、利伐沙班和下肢静脉泵等治疗并将手术时间控制在2小时以内的患者深静脉血栓发生率显著降低。术前卧床休息时间长,D-二聚体水平大于500ug/L,术后D-二聚体值比术前明显升高(差值大于术前50%),对深静脉血栓的发生有较高提示意义,应进一步结合临床表现及深静脉超声检查予以明确诊断。深静脉血栓预防策略应包括术前深静脉血栓风险评估、围手术期监测、规范的药物和康复治疗、以及出院定期随访,且该策略可有效降低深静脉血栓发生。
Objective:
To investigate the perioperative deep vein thrombosis incidence of total hip arthroplasty in orthopaedics department of the First Affiliated Hospital of Zhejiang University School of Medicine, and to analysis related factors and recommend some strategies of perioperative deep vein thrombosis preventions and treatments based on the results and discuss the strategies effects.
Method:
To investigate the patients clinical data as retrospective study in orthopaedics department of the First Affiliated Hospital of Zhejiang University School of Medicine from January2011to February2013. Followed the historical information and treatment records, collect the relevant information, including basic information, the main admission diagnosis before surgery combined with deep vein thrombosis-related diseases, preoperative blood lipid levels, peri-operative coagulation tests, D-dimer, surgery, operative time, blood loss, anesthesia, perioperative prevention and treatment measures, lower extremity DVT formation and lower limbs deep venous ultrasound results. All clinical cases are accordant with the relevant project assignment for count data. The statistical analysis software is SPSS16.0.
Results:
The number of patients with total hip arthroplasty surgery is178in orthopaedics department of the First Affiliated Hospital of Zhejiang University School of Medicine from January2011to February2013. In the first year, there were146patients totally,70males and78females, aged42-87years old, mean age at (68.1±8.7) years old. The numbers of DVT positive patients who are confirmed by the deep venous ultrasound are2, the rate was2.3%, the otherwise clinical symptoms or perioperative D-dimer was increasing significantly without lower extremity deep vein color Doppler ultrasound examinations are33cases, with suspected DVT incidence of37.5%. In the second year, there were150patients totally,76male cases,74female cases, aged31-97years, mean age (71.3±9.4). The numbers of DVT positive patients who are confirmed by the deep venous ultrasound are0, the incidence of0%, the otherwise clinical symptoms or perioperative D-dimer was increasing significantly without lower extremity deep vein color Doppler ultrasound examinations are19with suspected DVT incidence of21.1%. As related factors, the occurrence of DVT is higher in the patients age>70years than other patients. The gender showed non-significant effect on the occurrence of DVT. The occurrence of DVT was higher in the patients who have femoral neck fractures than that in the patients with osteoarthritis and developed dysplasia hip. The occurrence of DVT was higher in the patients with pulmonary disorders, tumors and diabetes mellitus than others. The occurrence of DVT was lower in the patients with shorter operative duration (<2hours). The application of medicine to modulate the dynamics of blood did not affect the occurrence of DVT significantly. The patients who were in bed for a long preoperative time or had the D-dimer higher than500ug/L, or higher than the D-dimer values before significantly (the difference is over than50%of the preoperative), should be confirmed by deep vein ultrasound because of significant higher incidence of DVT. The occurrence of DVT was lower in the patients underwent application of low molecular weight heparin, rivaroxaban and dressing vein pumps.
Conclutions:
The high risk factors of DVT in the patients with total hip arthrosplasty included age)70years, accompanied with pulmonary disorders or diabetes mellitus. The application of medicine to modulate the dynamics of blood was non-significant to decrease the occurrence of DVT. The use of low molecular weight heparin, rivaroxaban and dressing vein pump, shorter operative time (<2hours) were effective to decrease the occurrence of DVT in the patients with total hip arthroplasty. The patients in bed for a long preoperative time with the D-dimer higher than500ug/L, or than the D-dimer values before surgery significantly (the difference is over than50%of the preoperative), whose the incidence of deep vein thrombosis are higher significantly which should be confirmed by deep vein ultrasound. It is showed that the treatments of low molecular weight heparin, Rivaroxaban or dressing vein pumps should be used for deep vein thrombosis preventions.
调查研究浙江大学医学院附属第一医院骨科2011年至2013年行人工髋关节置换术的患者在围手术期下肢深静脉血栓的发生率,统计分析其相关影响因素,根据研究结果制定出围手术期的深静脉血栓预防治疗策略,并讨论分析其预防及治疗效果。
方法：
回顾性调查浙江大学医学院附属第一医院骨科从2011年1月至2013年2月行人工髋关节置换术的患者临床资料,根据其相关病史治疗记录,收集整理数据资料,包括患者的基本信息、入院主要诊断、入院合并症、血脂水平、凝血功能、D-二聚体水平、手术方式、手术时间、术中出血量、麻醉方式、围手术期预防治疗措施、下肢深静脉超声检查的结果等。各项病历资料根据相关研究赋值统计,统计软件使用SPSS16.0统计分析。
结果：
浙江大学医学院附属第一医院骨科从2011年1月至2013年2月行人工髋关节置换术的患者共计178例,男性86例,女性92例,年龄介于31-97岁,平均年龄(69.6±9.2)岁。第一年(从2011年1月至2011年12月),共计患者88例,男性40例,女性48例,年龄42-87岁,平均年龄(68.1±8.7)岁,经下肢深静脉超声检查确诊深静脉血栓的患者,即DVT显性患者为2例,发生率为2.3%；此外,有临床症状或围手术期D-二聚体明显升高但未经下肢深静脉超声检查的患者有33例,即隐性DVT患者有37.5%。第二年(2012年1月至2013年2月),共计患者90例,男性46例,女性44例,年龄31-97岁,平均年龄(71.3±9.4)岁,经下肢深静脉超声检查确诊下肢DVT形成(DVT显性患者)0例,发生率为0%,有临床症状或围手术期D-二聚体明显升高但未经下肢深静脉彩超检查的患者有19例,即隐性DVT发生率为21.1%。深静脉血栓发生的相关影响因素分析结果如下：年龄在70岁以上的患者较其他年龄段的患者深静脉血栓发生率明显上升；性别对深静脉血栓发生的影响不显著；入院主诊断为股骨颈骨折而接受人工全髋关节置换术的患者,较其他诊断如股骨头坏死或髋关节发育不良而接受人工全髋关节置换术的患者深静脉血栓发生率更高；术前合并有肺部疾病、肿瘤、糖尿病的患者围手术期深静脉血栓的发生率增加；手术时间超过2小时的患者深静脉血栓发生率增高；术前应用活血药物的患者其围手术期DVT的发生率无显著下降,术后应用规范的药物及物理抗凝治疗,如低分子肝素注射、利伐沙班口服抗凝治疗、下肢静脉泵等的患者深静脉血栓发生率降低；术前卧床休息的时间超过2周的患者发生深静脉血栓的概率增大；术前D-二聚体水平大于500ug/L,术后D-二聚体值比术前明显升高(差值大于术前50%)的患者,发生深静脉血栓的风险明显增大,尤其是伴有下肢肿胀等疑似深静脉血栓发生的临床表现患者,应进一步使用深静脉超声检查予以明确诊断治疗。
结论：
在接受人工全髋关节置换术的患者中,年龄段大于70岁且术前合并有糖尿病、肿瘤、肺部疾病的患者更容易发生深静脉血栓；术前应用活血药物不能显著降低深静脉血栓的发生率；围手术期规范应用低分子肝素、利伐沙班和下肢静脉泵等治疗并将手术时间控制在2小时以内的患者深静脉血栓发生率显著降低。术前卧床休息时间长,D-二聚体水平大于500ug/L,术后D-二聚体值比术前明显升高(差值大于术前50%),对深静脉血栓的发生有较高提示意义,应进一步结合临床表现及深静脉超声检查予以明确诊断。深静脉血栓预防策略应包括术前深静脉血栓风险评估、围手术期监测、规范的药物和康复治疗、以及出院定期随访,且该策略可有效降低深静脉血栓发生。
Objective:
To investigate the perioperative deep vein thrombosis incidence of total hip arthroplasty in orthopaedics department of the First Affiliated Hospital of Zhejiang University School of Medicine, and to analysis related factors and recommend some strategies of perioperative deep vein thrombosis preventions and treatments based on the results and discuss the strategies effects.
Method:
To investigate the patients clinical data as retrospective study in orthopaedics department of the First Affiliated Hospital of Zhejiang University School of Medicine from January2011to February2013. Followed the historical information and treatment records, collect the relevant information, including basic information, the main admission diagnosis before surgery combined with deep vein thrombosis-related diseases, preoperative blood lipid levels, peri-operative coagulation tests, D-dimer, surgery, operative time, blood loss, anesthesia, perioperative prevention and treatment measures, lower extremity DVT formation and lower limbs deep venous ultrasound results. All clinical cases are accordant with the relevant project assignment for count data. The statistical analysis software is SPSS16.0.
Results:
The number of patients with total hip arthroplasty surgery is178in orthopaedics department of the First Affiliated Hospital of Zhejiang University School of Medicine from January2011to February2013. In the first year, there were146patients totally,70males and78females, aged42-87years old, mean age at (68.1±8.7) years old. The numbers of DVT positive patients who are confirmed by the deep venous ultrasound are2, the rate was2.3%, the otherwise clinical symptoms or perioperative D-dimer was increasing significantly without lower extremity deep vein color Doppler ultrasound examinations are33cases, with suspected DVT incidence of37.5%. In the second year, there were150patients totally,76male cases,74female cases, aged31-97years, mean age (71.3±9.4). The numbers of DVT positive patients who are confirmed by the deep venous ultrasound are0, the incidence of0%, the otherwise clinical symptoms or perioperative D-dimer was increasing significantly without lower extremity deep vein color Doppler ultrasound examinations are19with suspected DVT incidence of21.1%. As related factors, the occurrence of DVT is higher in the patients age>70years than other patients. The gender showed non-significant effect on the occurrence of DVT. The occurrence of DVT was higher in the patients who have femoral neck fractures than that in the patients with osteoarthritis and developed dysplasia hip. The occurrence of DVT was higher in the patients with pulmonary disorders, tumors and diabetes mellitus than others. The occurrence of DVT was lower in the patients with shorter operative duration (<2hours). The application of medicine to modulate the dynamics of blood did not affect the occurrence of DVT significantly. The patients who were in bed for a long preoperative time or had the D-dimer higher than500ug/L, or higher than the D-dimer values before significantly (the difference is over than50%of the preoperative), should be confirmed by deep vein ultrasound because of significant higher incidence of DVT. The occurrence of DVT was lower in the patients underwent application of low molecular weight heparin, rivaroxaban and dressing vein pumps.
Conclutions:
The high risk factors of DVT in the patients with total hip arthrosplasty included age)70years, accompanied with pulmonary disorders or diabetes mellitus. The application of medicine to modulate the dynamics of blood was non-significant to decrease the occurrence of DVT. The use of low molecular weight heparin, rivaroxaban and dressing vein pump, shorter operative time (<2hours) were effective to decrease the occurrence of DVT in the patients with total hip arthroplasty. The patients in bed for a long preoperative time with the D-dimer higher than500ug/L, or than the D-dimer values before surgery significantly (the difference is over than50%of the preoperative), whose the incidence of deep vein thrombosis are higher significantly which should be confirmed by deep vein ultrasound. It is showed that the treatments of low molecular weight heparin, Rivaroxaban or dressing vein pumps should be used for deep vein thrombosis preventions.
引文
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[1]. Hull R, Raskob G. Pineo G, et al.A comparison of subcutaneous low molecular weight heparin with warfarin sodium for prophylaxis against deep vein thrombosis after hip or knee implantation. N Engl J Med 1993;329:1370-1376.
[2]Keeney JA, Clohisy JC, Curry MC, Maloney WJ.Efficacy of combined modality prophylaxis including short-duration warfarin to prevent venous thromboembolism after total hip arthroplasty. J Arthroplasty 2006; 21:469-475.
[3]Glyn-Jones S, Isaac S, Hauptfl eisch J, McLardy-Smith P, Murray DW, Gill HS. Does highly cross-linked polyethylene wear less than conventional polyethylene in total hip arthroplasty? A double-blind, randomized, and controlled trial using roentgen stereophotogrammetric analysis. J Arthroplasty 2008; 23:337-43.
[4]White RH. The epidemiology of venous thromboembolism. Circulayion,2003, 107(1):14-18.
[5]吕厚山,徐斌.人工关节置换术后下肢深静脉血栓志,1999,19(3)：156.
[6]Gillam MH. Ryan P. Graves SE. Miller LN, de Steiger RN, Salter A. Competing risks survival analysis applied to data from the Australian Orthopaedic Association National Joint Replacement Registry. Acta Orthop 2010; 81:548-55.
[7]Wilson D,Cooke EA,McNally Ma,et al.Altered venous function and deep venous thrombosis following proximal femoral fracture.Injury,2002,33:33-39.
[8]Manganelli D, Pazzagli M, Mazzantini D, et al. Prolonged prophylaxis with unfractionated heparin is effective to reduce delayed deep vein thrombosis in total hip replacement. Respiration.1998; 65:369-74.
[9]Caprini JA, Arcelus JI, Motykie G, Kudrna JC, Mokhtee D, Reyna JJ.The influence of oral anticoagulation therapy on deep vein thrombosis rates four weeks after total hip replacement. J Vase Surg 1999; 30:813-20.
[10]Kearon C. Natural history of venous thromboembolism. Circulation 2003; 107: 122-30.
[11]Mackman N, Becker RC. Dvt:A new era in anticoagulant therapy. Arterioscler Thromb Vase Biol,2010,30(3):369-371.
[12]张建政,刘树清,胥少汀.骨科围手术期血栓栓塞病的预防、诊断及治疗.中华外科杂志,2006,44(8)：565-567.
[13]Keener JD, Callaghan JJ, Goetz DD, Pederson DR, Sullivan PM, Johnston RC. Twenty-fi ve-year results after Charnley total hip arthroplasty in patients less than fi fly years old:a concise follow-up of a previous report. J Bone Joint Surg Am 2003; 85A: 1066-72.
[14]Hartman CW, Garvin KL. Femoral fixation in revision total hip arthroplasty. J Bone Joint Surg Am 2011; 93:2311-22.
[15]Lau J, Ioannidis JPA, Schmid CH. Summing up the evidence:one answer is not always enough. Lancet.1997; 351:123-27.
[16]Haake DA, Berkman SA.Venous thromboembolic disease after hip surgery. Risk factors, prophylaxis,and diagnosis.Clin Orthop Relat Res1989; (242):212-231.
[17]Robinson KS, Anderson DR, Gross M, et al. Ultrasonic screening before hospital discharge for deep vein thrombosis after arthroplasty:the post-arthroplasty screening study a randomised controlled trial.Ann Intern Med 1997; 127:439-45.
[18]田华,宋飞,张克等.阿司匹林预防关节置换术后血栓栓塞性疾病的疗效和安全性研究.中华医学杂志,2007,87(47)：3349-3352.
[19]White RH, Gettner S, Newman JM, Trauner KB, Romano PS. Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty. N Engl J Med 2000; 343:1758-64.
[20]Siopack JS, Jergesen HE. Total hip arthroplasty. West J Med 1995; 162:243-49.
[21]Teeny SM, York SC, Mesko JW, Rea RE. Long-term follow-up care recommend-ations after total hip and knee arthroplasty:results of the American Association of Hip and Knee Surgeons' member survey. J Arthroplasty 2003; 18:954-62.
[22]Zhu T, Martinez I, Emmerich J. Venous thromboembolism:risk factors for recurrence. Arterioscler Thromb Vasc Biol 2009; 29:298-310.
[23]Parvizi J, Wade FA, Rapuri V, Springer BD, Berry DJ, Hozack WJ. Revision hip arthroplasty for late instability secondary to polyethylene wear. Clin Orthop Relat Res 2006; 447:66-69.
[24]张晓文.全髋关节置换术后下肢深静脉血栓危险因素分析及防治.中国医刊,2011,46(9)：61-63.
[25]Jameson SS, Lees D, James P, et al. Lower rates of dislocation with increased femoral head size after primary total hip replacement:a five-year analysis of NHS patients in England. J Bone Joint Surg Br 2011; 93:876-80.
[26]Caprini JA, Arcelus JI, Motykie Q Kudrna JC, Mokhtee D, Reyna JJ. The influence of oral anticoagulation therapy on deep vein thrombosis rates four weeks after total hip replacement. J Vasc Surg 1999; 30:813-20.
[27]Langton DJ, Jameson SS, Joyce TJ, et al. Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg Br 2011; 93:1011-16.
[28]严伟.老年骨科手术患者下肢深静脉血栓的预防与治疗.中国老年学杂志2011,31(9)：1660-1661.
[29]Gallay S.Waddell JP,Cardella P.et al.A short course of Low-molecular-weight heparin to prevent deep venous thrombosis after elective total hip replacement.Can J Surg 1997;40(2):119-123.
[30]Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP. Berry DJ. The epidemiology of revision total hip arthroplasty in the United States.J Bone Joint Surg Am 2009; 91: 128-33.
[31]Callanan MC, Jarrett B, Bragdon CR, et al. The John Charnley Award:risk factors for cup malpositioning:quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res 2011; 469:319-29.
[32]Nicolaides AN. Prevention of venous thromboembolism:International Consensus Statement—guidelines compiled in accordance with the scientific evidence. Int Angiol 2001; 20:1-37.
[33]Manganelli D, Pazzagli M, Mazzantini D, et al. Prolonged prophylaxis with unfractionated heparin is effective to reduce delayed deep vein thrombosis in total hip replacement. Respiration.1998; 65:369-74.
[34]Eriksson BI, Dahl OE, Rosencher N, et al. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement:a randomised, double-blind, non-inferiority trial. Lancet 2007; 370:949-56.
[35]Eikelboom JW, Karthikeyan G, Fagel N, et al. American Association of Orthopedic Surgeons and American College of Chest Physicians guidelines for venous thromboem-bolism prevention in hip and knee arthroplasty differ:What are the implications for clinicians and patients? Chest 2009; 135:513-20.
[36]Colwell CW, Jr, Froimson MI, Mont MA, et al. Thrombosis prevention after total hip arthroplasty:a prospective, randomized trial comparing a mobile compression device with low-molecular-weight heparin. J Bone Joint Surg.2010;92-A:527-535.
[37]Rayan F, Dodd M, Haddad FS. European validation of the Vancouver classification of periprosthetic proximal femoral fractures.J Bone Joint Surg Br 2008; 90:1576-79.
[38]Dorr L D,Gendelman V.Multimodal thromboprophylaxis for total hip and knee arthroplasty based on risk Assessment J Bone Joint Sutg Am,2007,89(12):2648-2657.
[39]Novicoff WM, Brown TE, Cui Q, et al. Mandated venous thromboembolism prophylaxis:possible adverse outcomes. J Arthroplasty 2008; 23:15-19.
[40]Kakkar AK, Davidson BL, Haas SK. Compliance with recommended prophylaxis for venous thromboembolism:improving the use and rate of uptake of clinical practice guidelines. J Thromb Haemost 2004; 2:221-7.
[41]Khatod M, Barber T, Paxton E, Namba R, Fithian D. An analysis of the risk of hip dislocation with a contemporary total joint registry.Clin Orthop Relat Res 2006; 447: 19-23.
[42]Gillam MH, Ryan P, Graves SE, Miller LN, de Steiger RN, Salter A. Competing risks survival analysis applied to data from the Australian Orthopaedic Association National Joint Replacement Registry. Acta Orthop 2010; 81:548-55.
[43]Schulz KF, Chalmers I, Hayes RJ, Altman DG Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA.1995; 273:408-12.
[44]Hull RD, Pineo GF, Francis C, et al. Low-molecular-weight heparin prophylaxis using dalteparin extended out-of-hospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients:a double blind, randomized comparison. North American Fragmin Trial Investigators.Arch Intern Med 2000; 160:2208-15.
[45]Dahl OE.Mechanisms of hypercoagulability. Thromb Haemostl999; 82:902-6.
[46]Thamas D. Venous thrombogenesis. Br Med Bull,1994,50(4):803
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[37]Restrepo C, Mortazavi SM, Brothers J, Parvizi J, Rothman RH. Hip dislocation: are hip precautions necessary in anterior approaches? Clin Orthop Relat Res 2011; 469: 417-22.
[1]. Hull R, Raskob G. Pineo G, et al.A comparison of subcutaneous low molecular weight heparin with warfarin sodium for prophylaxis against deep vein thrombosis after hip or knee implantation. N Engl J Med 1993;329:1370-1376.
[2]Keeney JA, Clohisy JC, Curry MC, Maloney WJ.Efficacy of combined modality prophylaxis including short-duration warfarin to prevent venous thromboembolism after total hip arthroplasty. J Arthroplasty 2006; 21:469-475.
[3]Glyn-Jones S, Isaac S, Hauptfl eisch J, McLardy-Smith P, Murray DW, Gill HS. Does highly cross-linked polyethylene wear less than conventional polyethylene in total hip arthroplasty? A double-blind, randomized, and controlled trial using roentgen stereophotogrammetric analysis. J Arthroplasty 2008; 23:337-43.
[4]White RH. The epidemiology of venous thromboembolism. Circulayion,2003, 107(1):14-18.
[5]吕厚山,徐斌.人工关节置换术后下肢深静脉血栓志,1999,19(3)：156.
[6]Gillam MH. Ryan P. Graves SE. Miller LN, de Steiger RN, Salter A. Competing risks survival analysis applied to data from the Australian Orthopaedic Association National Joint Replacement Registry. Acta Orthop 2010; 81:548-55.
[7]Wilson D,Cooke EA,McNally Ma,et al.Altered venous function and deep venous thrombosis following proximal femoral fracture.Injury,2002,33:33-39.
[8]Manganelli D, Pazzagli M, Mazzantini D, et al. Prolonged prophylaxis with unfractionated heparin is effective to reduce delayed deep vein thrombosis in total hip replacement. Respiration.1998; 65:369-74.
[9]Caprini JA, Arcelus JI, Motykie G, Kudrna JC, Mokhtee D, Reyna JJ.The influence of oral anticoagulation therapy on deep vein thrombosis rates four weeks after total hip replacement. J Vase Surg 1999; 30:813-20.
[10]Kearon C. Natural history of venous thromboembolism. Circulation 2003; 107: 122-30.
[11]Mackman N, Becker RC. Dvt:A new era in anticoagulant therapy. Arterioscler Thromb Vase Biol,2010,30(3):369-371.
[12]张建政,刘树清,胥少汀.骨科围手术期血栓栓塞病的预防、诊断及治疗.中华外科杂志,2006,44(8)：565-567.
[13]Keener JD, Callaghan JJ, Goetz DD, Pederson DR, Sullivan PM, Johnston RC. Twenty-fi ve-year results after Charnley total hip arthroplasty in patients less than fi fly years old:a concise follow-up of a previous report. J Bone Joint Surg Am 2003; 85A: 1066-72.
[14]Hartman CW, Garvin KL. Femoral fixation in revision total hip arthroplasty. J Bone Joint Surg Am 2011; 93:2311-22.
[15]Lau J, Ioannidis JPA, Schmid CH. Summing up the evidence:one answer is not always enough. Lancet.1997; 351:123-27.
[16]Haake DA, Berkman SA.Venous thromboembolic disease after hip surgery. Risk factors, prophylaxis,and diagnosis.Clin Orthop Relat Res1989; (242):212-231.
[17]Robinson KS, Anderson DR, Gross M, et al. Ultrasonic screening before hospital discharge for deep vein thrombosis after arthroplasty:the post-arthroplasty screening study a randomised controlled trial.Ann Intern Med 1997; 127:439-45.
[18]田华,宋飞,张克等.阿司匹林预防关节置换术后血栓栓塞性疾病的疗效和安全性研究.中华医学杂志,2007,87(47)：3349-3352.
[19]White RH, Gettner S, Newman JM, Trauner KB, Romano PS. Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty. N Engl J Med 2000; 343:1758-64.
[20]Siopack JS, Jergesen HE. Total hip arthroplasty. West J Med 1995; 162:243-49.
[21]Teeny SM, York SC, Mesko JW, Rea RE. Long-term follow-up care recommend-ations after total hip and knee arthroplasty:results of the American Association of Hip and Knee Surgeons' member survey. J Arthroplasty 2003; 18:954-62.
[22]Zhu T, Martinez I, Emmerich J. Venous thromboembolism:risk factors for recurrence. Arterioscler Thromb Vasc Biol 2009; 29:298-310.
[23]Parvizi J, Wade FA, Rapuri V, Springer BD, Berry DJ, Hozack WJ. Revision hip arthroplasty for late instability secondary to polyethylene wear. Clin Orthop Relat Res 2006; 447:66-69.
[24]张晓文.全髋关节置换术后下肢深静脉血栓危险因素分析及防治.中国医刊,2011,46(9)：61-63.
[25]Jameson SS, Lees D, James P, et al. Lower rates of dislocation with increased femoral head size after primary total hip replacement:a five-year analysis of NHS patients in England. J Bone Joint Surg Br 2011; 93:876-80.
[26]Caprini JA, Arcelus JI, Motykie Q Kudrna JC, Mokhtee D, Reyna JJ. The influence of oral anticoagulation therapy on deep vein thrombosis rates four weeks after total hip replacement. J Vasc Surg 1999; 30:813-20.
[27]Langton DJ, Jameson SS, Joyce TJ, et al. Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg Br 2011; 93:1011-16.
[28]严伟.老年骨科手术患者下肢深静脉血栓的预防与治疗.中国老年学杂志2011,31(9)：1660-1661.
[29]Gallay S.Waddell JP,Cardella P.et al.A short course of Low-molecular-weight heparin to prevent deep venous thrombosis after elective total hip replacement.Can J Surg 1997;40(2):119-123.
[30]Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP. Berry DJ. The epidemiology of revision total hip arthroplasty in the United States.J Bone Joint Surg Am 2009; 91: 128-33.
[31]Callanan MC, Jarrett B, Bragdon CR, et al. The John Charnley Award:risk factors for cup malpositioning:quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res 2011; 469:319-29.
[32]Nicolaides AN. Prevention of venous thromboembolism:International Consensus Statement—guidelines compiled in accordance with the scientific evidence. Int Angiol 2001; 20:1-37.
[33]Manganelli D, Pazzagli M, Mazzantini D, et al. Prolonged prophylaxis with unfractionated heparin is effective to reduce delayed deep vein thrombosis in total hip replacement. Respiration.1998; 65:369-74.
[34]Eriksson BI, Dahl OE, Rosencher N, et al. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement:a randomised, double-blind, non-inferiority trial. Lancet 2007; 370:949-56.
[35]Eikelboom JW, Karthikeyan G, Fagel N, et al. American Association of Orthopedic Surgeons and American College of Chest Physicians guidelines for venous thromboem-bolism prevention in hip and knee arthroplasty differ:What are the implications for clinicians and patients? Chest 2009; 135:513-20.
[36]Colwell CW, Jr, Froimson MI, Mont MA, et al. Thrombosis prevention after total hip arthroplasty:a prospective, randomized trial comparing a mobile compression device with low-molecular-weight heparin. J Bone Joint Surg.2010;92-A:527-535.
[37]Rayan F, Dodd M, Haddad FS. European validation of the Vancouver classification of periprosthetic proximal femoral fractures.J Bone Joint Surg Br 2008; 90:1576-79.
[38]Dorr L D,Gendelman V.Multimodal thromboprophylaxis for total hip and knee arthroplasty based on risk Assessment J Bone Joint Sutg Am,2007,89(12):2648-2657.
[39]Novicoff WM, Brown TE, Cui Q, et al. Mandated venous thromboembolism prophylaxis:possible adverse outcomes. J Arthroplasty 2008; 23:15-19.
[40]Kakkar AK, Davidson BL, Haas SK. Compliance with recommended prophylaxis for venous thromboembolism:improving the use and rate of uptake of clinical practice guidelines. J Thromb Haemost 2004; 2:221-7.
[41]Khatod M, Barber T, Paxton E, Namba R, Fithian D. An analysis of the risk of hip dislocation with a contemporary total joint registry.Clin Orthop Relat Res 2006; 447: 19-23.
[42]Gillam MH, Ryan P, Graves SE, Miller LN, de Steiger RN, Salter A. Competing risks survival analysis applied to data from the Australian Orthopaedic Association National Joint Replacement Registry. Acta Orthop 2010; 81:548-55.
[43]Schulz KF, Chalmers I, Hayes RJ, Altman DG Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA.1995; 273:408-12.
[44]Hull RD, Pineo GF, Francis C, et al. Low-molecular-weight heparin prophylaxis using dalteparin extended out-of-hospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients:a double blind, randomized comparison. North American Fragmin Trial Investigators.Arch Intern Med 2000; 160:2208-15.
[45]Dahl OE.Mechanisms of hypercoagulability. Thromb Haemostl999; 82:902-6.
[46]Thamas D. Venous thrombogenesis. Br Med Bull,1994,50(4):803
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