人工膝関節全置換術における深部静脈血栓症のスクリーニングの確立～発生時期，危険因子，片両側比較の検討から～

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  • Establishing a Method for Screening Deep Vein Thrombosis in Total Knee Arthroplasty – A Comparison of Onset, Risk Factors, and Unilateral and Bilateral Procedures
  • ジンコウ シツカンセツ ゼン チカンジュツ ニ オケル シンブ ジョウミャク ケッセンショウ ノ スクリーニング ノ カクリツ : ハッセイ ジキ,キケン インシ,カタ リョウガワ ヒカク ノ ケントウ カラ

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Objective: Deep vein thrombosis (DVT) is a known perioperative complication from total knee arthroplasty (TKA), and is a major cause of fatal pulmonary embolism. However, methods for screening DVT have not been well established. The purpose of this study was to establish a method for screening DVT after TKA by comparing the onset of DVT, associated risk factors as well as the comparison between unilateral and bilateral TKA cases.<br>Methods: There were 659 subjects who were evaluated for DVT postoperatively following TKA. There were 576 unilateral TKA cases and 83 bilateral TKA cases, respectively. The incidence of DVT, the time of onset of thrombosis and the associated risk factors were also examined.<br>Results: The incidence of DVT after TKA was 24.5% in unilateral cases and 42.0% in bilateral cases, respectively. Regarding onset of DVT, the incidence during postoperative (PO) days 1-2 was significantly higher in both unilateral and bilateral cases (P < 0.01), but with it being significantly higher in bilateral cases (P < 0.01). The significant risk factors of DVT included older age more than 73.0 years (P < 0.05), female sex (P < 0.05), body mass index more than 26.4 (P < 0.05), preoperative D-dimer value more than 1.9ng/ml (P < 0.05), D-dimer value at PO day 1 more than 77.8ng/ml (P < 0.01), D-dimer value at PO day 7 more than 11.7ng/ml (P < 0.05), and preoperative presence of DVT (P < 0.01), respectively.<br>Conclusion: DVT associated with TKA develops within two days postoperatively in many cases, while it develops at day 14 with a higher frequency in bilateral cases compared with unilateral cases. This study indicates that it is acceptable to perform DVT screening for up to seven days in cases of unilateral TKA, but this should be extended by a further seven days in cases of bilateral TKA to ensure that DVT is not missed in this high risk group.

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