ObjectiveTo evaluate the value of clinical application of determination of lower venous pressure in the diagnosis and treatment of deep venous thrombosis (DVT). MethodsThe 90 patients with DVT of unilateral lower limb who were admitted by using color Doppler or deep veins of lower limb angiography in our hospital during the period of 2013 July to 2014 June were selected and as the research object (case group), 37 cases were male, 53 cases were female; the age was 18-84 years old, mean age was 59.48 years old. According to the development of disease, 90 cases were divided into acute 30 cases, subacute 30 cases, and chronic 30 cases; and according to the pathological types were divided into the central type in 30 cases, 30 cases of peripheral type, and 30 cases of mixed type. At the same time the without lower extremity DVT volunteers of 20 cases were selected as normal control group, including male 9 cases, female 11 cases; age was 21-65 years old, average age was 38.7 years old. The static venous pressure (P0), dynamic venous pressure (P00), and decreased pressure ratio (Pd) of double lower limbs of participants in 2 groups were determinated and comparative analyzed. ResultsThe P0 and P00 of patients with different development of disease and pathological types of the case group were higher than those of the normal control group (P < 0.01), and the Pd was lower than that of the normal control group (P < 0.01). In case group, the P0 and P00 of acute phase were higher than those of the normal control group (P < 0.01), the P0 of central type was higher than that of the peripheral type and mixed type (P < 0.01), and the Pd central type was lower than that of mixed type (P < 0.01). The above 3 indexes' differences of double lower limbs in the normal control group had no statistical significance (P > 0.01). In case group, the P0 and P00 of ipsilateral limb in different development of disease and pathological types were higher than those of the healthy limb, and the Pd were lower than that of the healthy limb (P < 0.01). ConclusionsLower extremity venous pressure measurements can be used in clinical detection for early lower limb DVT, and can be used as the objective index of clinical evaluation curative effect for the treatment of DVT. It is a simple and practical clinical detection method.
Objective To analyze the relation between the mode of delivery and postpartum lower extremity deep venous thrombosis （DVT）， and discuss the therapy methods. Methods The clinical data of 48 patients with postpartum lower extremity DVT from 2006 to 2012 in this hospital were analyzed retrospectively. Results There were 15 897 patients with the delivery， of whom were 10 097 cases of cesarean section and 5 800 cases of spontaneous delivery， the incidence rate of lower extremity DVT in the patients with cesarean section was significantly higher than that in the patients with spontaneous delivery〔0.41% （41/10 097） versus 0.12% （7/5 800）， χ2=9.94，P＜0.005〕. The higher incidence rate of cesarean section， the higher incidence rate of lower extremity DVT， which was a positive correlation between them （rs=0.87，P＜0.05）. Forty-three cases were only treated by drug therapy， 2 cases were performed operation combined with drug therapy， and 5 cases were placed the inferior vena cava filter. Forty-eight cases were cured and discharged. Conclusions The incidence rate of lower extremity DVT of cesarean section is higher as compared with the spontaneous delivery. The thrombolysis and （or） anticoagulation therapy is an effective way in the treatment for DVT. Controlling indications of cesarean section and early postpartum out-of-bed can decrease the DVT.
ObjectiveTo investigate the incidence of perioperative deep venous thrombosis (DVT) of lower extremities and its risk factors in elderly patients with femoral neck fracture. Methods The clinical data of 4 109 elderly patients with femoral neck fracture admitted between August 2012 and November 2020 and met the selection criteria were retrospectively analyzed. Among them, there were 1 137 males and 2 972 females; their ages ranged from 65 to 101 years, with an average of 77.0 years. The time from fracture to admission ranged from 1 to 360 hours, with an average of 35.2 hours. There were 1 858 cases of hemiarthroplasty, 1 617 cases of total hip arthroplasty, and 634 cases of internal fixation surgery. The preoperative age-adjusted Charlson comorbidity index (aCCI) was 4 (3, 5). Perioperative DVT occurred in 857 cases (20.9%). Univariate analysis was performed on age, gender, body mass index, fracture side, time from fracture to admission, operation type, anesthesia type, blood transfusion, blood pressure after admission, and preoperative aCCI in patients with and without perioperative DVT, and logistic regression analysis was used to screen the risk factors of perioperative DVT in elderly patients with femoral neck fracture. ResultsUnivariate analysis showed that there were significant differences in age, gender, time from fracture to admission, operation type, and preoperative aCCI between the two groups (P<0.05). Further logistic regression analysis showed that age>75 years, female patients, time from fracture to admission>24 hours, and preoperative aCCI>5 were risk factors for perioperative DVT (P<0.05). Conclusion Elderly patients with femoral neck fracture have a higher incidence of perioperative DVT. The advanced aged and female patients, patients with longer fracture time and more comorbidities need to pay special attention to the prevention of perioperative DVT to minimize the occurrence of DVT during femoral neck fractures.
ObjectiveTo explore the correlation between the Barthel index score and other factors with the preoperative occurrence of deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA) revision surgery. MethodsA retrospective analysis was conducted on clinical data from 122 patients who met the inclusion criteria and underwent THA revision surgery between April 2017 and November 2020. Among them, 61 were male and 61 were female, with an age range of 32-85 years (mean, 65.3 years). The reasons for revision included prosthetic joint infection in 7 cases, periprosthetic fracture in 4 cases, prosthetic dislocation in 6 cases, and aseptic loosening in 105 cases. The Barthel index score was 76.4±17.7, with 10 cases classified as level 1, 57 as level 2, 37 as level 3, and 18 as level 4. Univariate analysis was performed on variables such as age, gender, body mass index, Barthel index score, preoperative D-dimer positivity, history of diabetes, hypertension, cancer, cerebral infarction, smoking, and thrombosis in patients with and without preoperative DVT. Furthermore, logistic regression was used to identify risk factors for preoperative DVT in THA revision surgery. The incidence of preoperative DVT was compared among different Barthel index score groups. ResultsPreoperative DVT was detected in 11 patients (9.02%), all of whom had intermuscular venous thrombosis. Among them, 1 had prosthetic joint infection, 1 had periprosthetic fracture, 1 had prosthetic dislocation, and 8 had aseptic loosening. Univariate analysis showed significant differences between the two groups in terms of age, gender, and Barthel index score (P<0.05). logistic regression further revealed that female, age ≥70 years, and Barthel index score<60 were independent risk factors for preoperative DVT in patients undergoing THA revision surgery (P<0.05). The incidence of preoperative DVT in patients with Barthel index scores of levels 1, 2, 3, and 4 were 0 case (0%), 2 cases (3.5%), 3 cases (8.1%), and 6 cases (33.3%), respectively. A significant correlation was found between Barthel index score classification and the incidence of preoperative DVT in patients undergoing THA revision surgery (χ2=10.843, P=0.001). ConclusionIn patients undergoing THA revision surgery, older age, female, and lower Barthel index scores are associated with higher preoperative DVT incidence. For patients with low preoperative Barthel index scores, preoperative thrombosis screening should be emphasized.
Objective To explore the results of thrombolytic therapy of acute deep vein thrombosis of lower extremity. Methods The clinical data of 126 patients with acute deep vein thrombosis of lower extremity treated conservatively from Dec.1999 to Feb.2004 were analyzed retrospectively. Results All patients were divided into three groups: 26 of central, 33 of surrounding and 67 of combined by Doppler sonography. Combined medication was adopted in all cases, in which 85 cases (67.5%) were clinically cured, 34 cases (27.0%) had good results, and 5 cases (4.0%) recovered partially. Two cases (1.6%) didn’t get better. The total effective rate was 98.4% (124/126). Conclusion Most patients with acute deep vein thrombosis of lower extremity can get satisfied results with conservative treatment including thrombolysis and anticoagulation. Early diagnosis and appropriate medication are crucial.
Objective To explore the therapeutic effect of catheter-directed thrombolysis combined with vena cava filter on deep venous thrombosis (DVT) of lower extremity.Methods The clinical data of 65 patients with DVT of lower extremities from January 2008 to August 2009 were analyzed retrospectively, whose course of diseases were not more than 7 d and clinical type included central type and mixed type. Thirty-two cases were treated with catheter-directed thrombolysis combined with vena cava filter, while administrating treatment of anticoagulation and activating blood circulation to dissipate blood stasis, which were named as study group. Thirty-three cases were treated traditionally with thrombolysis, anticoagulation, and activating blood circulation to dissipate blood stasis, which were named as control group. The course of therapy was continued 10-14 d, then the efficacy in two groups patients was evaluated. Results It was (7.35±1.42) cm that circumference difference before treatment between affected extremties and unaffected extremties in study group, which of 3, 7, and 14 d after treatment was (4.21±1.12) cm， (2.87±0.98) cm, and (1.22±1.02) cm, respectively. Circumference difference between before and after treatment had significant difference in study group (Plt;0.01). It was (6.97±1.27) cm that circumference difference before treatment between affected extremties and unaffected extremties in control group, which of 3, 7, and 14 d after treatment was (5.72±1.31) cm, (4.58±0.88) cm, and (3.18±1.24) cm, respectively. Circumference difference between before treatment and 3, 7, and 14 d after treatment had significant difference in control group (Plt;0.05 or Plt;0.01). Circumference difference before treatment in two groups had no significant difference (Pgt;0.05). Circumference difference after treatment at different time points in two groups was significantly different, respectively (Plt;0.01). Circumference difference after treatment at different time points in study group was significantly less than that in control group, respectively (Plt;0.01). After 14 d, complete recanalization rate （71.88%, 23/32） and cure rate (71.88%, 23/32) of iliofemoral vein in study group were significant higher than that (36.36%, 12/33) in control group (Plt;0.01). No pulmonary embolism occurred. Conclusion In terms of ideal therapy targets of DVT of lower extremity, the catheterdirected thrombolysis combined with vena cava filter is obviously superior to traditional thrombolysis treatment.
Objective To explore the impact of anemia on the incidence of perioperative lower limb deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA). Methods A retrospective analysis was conducted on clinical data of 1 916 non-fracture patients who underwent THA between September 2015 and December 2021, meeting the selection criteria. Among them, there were 811 male and 1 105 female patients, aged between 18 and 94 years with an average of 59.2 years. Among the patients, 213 were diagnosed with anemia, while 1 703 were not. Preoperative DVT was observed in 55 patients, while 1 861 patients did not have DVT preoperatively (of which 75 patients developed new-onset DVT postoperatively). Univariate analysis was performed on variables including age, gender, body mass index (BMI), diabetes, hypertension, history of tumors, history of thrombosis, history of smoking, revision surgery, preoperative D-dimer positivity (≥0.5 mg/L), presence of anemia, operation time, intraoperative blood loss, transfusion requirement, and pre- and post-operative levels of red blood cells, hemoglobin, hematocrit, and platelets. Furthermore, logistic regression was utilized for multivariate analysis to identify risk factors associated with DVT formation. Results Univariate analysis showed that age, gender, hypertension, revision surgery, preoperative levels of red blood cells, preoperative hemoglobin, preoperative D-dimer positivity, and anemia were influencing factors for preoperative DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, preoperative D-dimer positivity, and anemia were risk factors for preoperative DVT (P<0.05). Univariate analysis also revealed that age, female, revision surgery, preoperative D-dimer positivity, anemia, transfusion requirement, postoperative level of red blood cells, and postoperative hemoglobin level were influencing factors for postoperative new-onset DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, and revision surgery were risk factors for postoperative new-onset DVT (P<0.05). Conclusion The incidence of anemia is higher among patients with preoperative DVT for THA, and anemia is an independent risk factor for preoperative DVT occurrence in THA. While anemia may not be an independent risk factor for THA postoperative new-onset DVT, the incidence of anemia is higher among patients with postoperative new-onset DVT.
Objective To investigate the short-term result of catheter directed thrombolysis (CDT) in treatment of acute deep venous thrombosis (DVT) in lower extremity. Methods A total of 289 cases of acute DVT in lower extremity who got treatment in Nanjing Drum Tower Hospital Group Suqian City People’s Hospital and Xuzhou Central Hospital from March 2013 to December 2014 were enrolled prospectively, and of them, 125 cases of system thrombolysis (ST) group underwent ST, 164 cases of CDT group underwent inferior vena cava filter placement (IVCF)+CDT. Clinical effect was compared between the 2 groups. Results Clinical symptoms of all cases were obviously relieved, and limb swelling was significantly reduced. Of the CDT group, 73 cases presented iliac vein compression syndrome (IVCS), and 43 cases of them underwent the percutaneous transluminal angioplasty and stent implantation. In CDT group, there was 1 case complicated by catheter displacement, 10 cases suffered from puncture site ecchymosis, 3 cases suffered from hematuria. In ST group, there was 1 case suffered from pulmonary embolism (PE), 14 cases suffered from bleeding gums, 22 cases suffered from hematuria, 3 cases suffered from skin and mucosa petechia, and 2 cases suffered from melena (didn’t need transfusion). The morbidity of ST group was higher than that of CDT group (P=0.002). There were 18 cases suffered from recurrence in ST group, 15 cases suffered from recurrence in CDT group, but there was no significant difference in the recurrence rate between the 2 groups (P=0.786). In addition, the dosage of urokinase, thrombolysis time, blood vessel patency score, thigh circumference after treatment, and calf circumference after treatment in ST group were all higher than those of CDT group (P<0.050), but the Villalta score in ST group was lower than that of CDT group (P<0.001). There was no significant difference in hospital stay (P=0.383). Conclusion For acute DVT in lower extremity, CDT has a superior short-term outcome with safety and feasibility.
目的研究置管溶栓联合球囊扩张导管碎栓治疗下肢深静脉血栓形成（DVT）的疗效及安全性。 方法回顾性分析2011年9月至2015年1月本院收治的82例急性下肢DVT患者的临床资料。将患者分成两组：A组行单纯经导管直接溶栓（CDT）治疗，共32例，其中男10例、女22例，平均年龄（56±15）岁；B组行CDT联合机械碎栓（球囊扩张导管碎栓）治疗，共50例，其中男18例、女32例，平均年龄（57±17）岁。比较2组治疗前后静脉通畅率、静脉通畅度评分、健侧和患侧下肢周径差，比较2组尿激酶用量及溶栓导管留置时间，以出血并发症、肺栓塞的发生率评价治疗的安全性。 结果2组共82例患者完成溶栓及碎栓疗程，B组较A组溶栓时间更短，A组平均9（7，12）d；B组平均5（4，7）d，2组差异有统计学意义（P<0.01）；B组较A组尿激酶用量更少，A组平均7.250（6.355，8.255）×106 U，B组平均4.925（3.715，5.810）×106 U，2组差异有统计学意义（P<0.01）；B组治疗后的静脉通畅度评分显著优于A组，A组65.0%（40.5%，86.5%），B组为100%（90%，100%），差异有统计学意义（P<0.01）。治疗后2组出血并发症发生率差异无统计学意义（P=0.0976）。2组患者随访时间3～18个月，A组随访率50.0%，B组随访率58.0%，均未发生肺动脉栓塞。 结论在下腔静脉滤器保护下，CDT联合球囊扩张导管碎栓治疗急性下肢DVT较单纯CDT治疗，溶栓效果好、尿激酶用量少、不增加肺栓塞及出血发生率。
Objective A prospective randomized controlled trial was conducted to study the effectiveness and safety of intravenous different doses tranexamic acid (TXA) in single-level unilateral minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods The patients treated with single-level unilateral MIS-TLIF between September 2019 and October 2020 were enrolled and randomly classified into low-dose TXA (LD) group (n=39), high-dose TXA (HD) group (n=39), and placebo-controlled (PC) group (n=38). The LD, HD, and PC groups received intravenous TXA 20 mg/kg, TXA 50 mg/kg, the same volume of normal saline at 30 minute before skin incision after general anesthesia, respectively. There was no significant difference on baseline characteristics and preoperative laboratory results among 3 groups (P>0.05), including age, gender, body mass index, surgical segments, hematocrit (HCT), hemoglobin (HGB), prothrombin time (PT), international normalized ratio (INR), D-dimer, fibrin degradation products (FDP), activated partial prothromboplastin time (APTT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr), urea. The intraoperative blood loss (IBL), postoperative drainage volume, operation time, total blood loss (TBL), hidden blood loss (HBL), blood transfusion, hematological examination indexes on the first day after operation, and the incidence of complications within 1 month were compared among the 3 groups. Results There were 3, 2, and 4 patients in the LD, HD, and PC groups who underwent autologous blood transfusion, respectively, and there was no allogeneic blood transfusion patients in the 3 groups. There was no significant difference in IBL, postoperative drainage volume, and operation time between groups (P>0.05). The TBL, HBL, and the decreased value of HGB in LD and HD groups were significantly lower than those in PC group (P<0.05), and TBL and HBL in HD group were significantly lower than those in LD group (P<0.05); the decreased value of HGB between LD group and HD group showed no significant difference (P>0.05). On the first day after operation, D-dimer in LD and HD groups were significantly lower than that in PC group (P<0.05); there was no significant difference between LD and HD groups (P>0.05). There was no significant difference in other hematological indexes between groups (P>0.05). All patients were followed up 1 month, and there was no TXA-related complication such as deep venous thrombosis of lower extremity, pulmonary embolism, and epilepsy in the 3 groups. ConclusionIntravenous administration of TXA in single-level unilateral MIS-TLIF is effective and safe in reducing postoperative TBL and HBL within 1 day in a dose-dependent manner. Also, TXA can reduce postoperative fibrinolysis markers and do not increase the risk of thrombotic events, including deep venous thrombosis and pulmonary embolism.