中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2013年
8期
444-447
,共4页
闫沛云%宋朝基%苗生龙%王冬%毕虎
閆沛雲%宋朝基%苗生龍%王鼕%畢虎
염패운%송조기%묘생룡%왕동%필호
全髋人工关节置换%深静脉血栓%诊断%低分子肝素
全髖人工關節置換%深靜脈血栓%診斷%低分子肝素
전관인공관절치환%심정맥혈전%진단%저분자간소
Total hip arthroplasty ( THA )%Deep vein thrombosis ( DVT )%Diagnosis%Low molecular weight heparin ( LMWH )
目的探索全髋人工关节置换患者围手术期 D-二聚体( D-dimer，DD )、血浆纤维蛋白原( fibrinogen，FIB )和纤维蛋白降解产物( fibrin degradation product，FDP )在下肢深静脉血栓形成中的诊断价值和各自的敏感性与特异性。方法对2008年6月至2012年6月，在我科行全髋人工关节置换( total hip arthroplastic，THA )的168例患者分别于术前和术后第1、3、7天进行血浆 DD、FIB、FDP 的检测；术前和术后第3、7天应用彩色多普勒超声血流探测仪检测患者双下肢深静脉血栓( deep vein thrombosis，DVT )的形成。按照彩色多普勒超声血流探测仪检测结果将患者分为 DVT 阳性组和 DVT 阴性组，分析 DD、FIB、FDP 对于全髋人工关节置换术后 DVT 形成的诊断价值和各自的敏感性与特异性。结果术后32例患者发生 DVT，占19.1%。在检测的3个指标中，DD、FDP 的受试者工作特征曲线( receiver operating characteristic， ROC )下面积分别为81.8%( P＝0.002)和68.4%( P＝0.009)。FIB 曲线下的面积仅为56.3%( P＝0.31)。结论DD 和 FDP 在全髋人工关节置换术后 DVT 的形成中有诊断意义。FIB 对于在全髋人工关节置换术后 DVT 形成中的诊断意义较低。术后及时检测 DD 和 FDP 可以及时发现 DVT，避免肺动脉血栓栓塞症( pulmonary thromboembolism，PTE )的发生。
目的探索全髖人工關節置換患者圍手術期 D-二聚體( D-dimer，DD )、血漿纖維蛋白原( fibrinogen，FIB )和纖維蛋白降解產物( fibrin degradation product，FDP )在下肢深靜脈血栓形成中的診斷價值和各自的敏感性與特異性。方法對2008年6月至2012年6月，在我科行全髖人工關節置換( total hip arthroplastic，THA )的168例患者分彆于術前和術後第1、3、7天進行血漿 DD、FIB、FDP 的檢測；術前和術後第3、7天應用綵色多普勒超聲血流探測儀檢測患者雙下肢深靜脈血栓( deep vein thrombosis，DVT )的形成。按照綵色多普勒超聲血流探測儀檢測結果將患者分為 DVT 暘性組和 DVT 陰性組，分析 DD、FIB、FDP 對于全髖人工關節置換術後 DVT 形成的診斷價值和各自的敏感性與特異性。結果術後32例患者髮生 DVT，佔19.1%。在檢測的3箇指標中，DD、FDP 的受試者工作特徵麯線( receiver operating characteristic， ROC )下麵積分彆為81.8%( P＝0.002)和68.4%( P＝0.009)。FIB 麯線下的麵積僅為56.3%( P＝0.31)。結論DD 和 FDP 在全髖人工關節置換術後 DVT 的形成中有診斷意義。FIB 對于在全髖人工關節置換術後 DVT 形成中的診斷意義較低。術後及時檢測 DD 和 FDP 可以及時髮現 DVT，避免肺動脈血栓栓塞癥( pulmonary thromboembolism，PTE )的髮生。
목적탐색전관인공관절치환환자위수술기 D-이취체( D-dimer，DD )、혈장섬유단백원( fibrinogen，FIB )화섬유단백강해산물( fibrin degradation product，FDP )재하지심정맥혈전형성중적진단개치화각자적민감성여특이성。방법대2008년6월지2012년6월，재아과행전관인공관절치환( total hip arthroplastic，THA )적168례환자분별우술전화술후제1、3、7천진행혈장 DD、FIB、FDP 적검측；술전화술후제3、7천응용채색다보륵초성혈류탐측의검측환자쌍하지심정맥혈전( deep vein thrombosis，DVT )적형성。안조채색다보륵초성혈류탐측의검측결과장환자분위 DVT 양성조화 DVT 음성조，분석 DD、FIB、FDP 대우전관인공관절치환술후 DVT 형성적진단개치화각자적민감성여특이성。결과술후32례환자발생 DVT，점19.1%。재검측적3개지표중，DD、FDP 적수시자공작특정곡선( receiver operating characteristic， ROC )하면적분별위81.8%( P＝0.002)화68.4%( P＝0.009)。FIB 곡선하적면적부위56.3%( P＝0.31)。결론DD 화 FDP 재전관인공관절치환술후 DVT 적형성중유진단의의。FIB 대우재전관인공관절치환술후 DVT 형성중적진단의의교저。술후급시검측 DD 화 FDP 가이급시발현 DVT，피면폐동맥혈전전새증( pulmonary thromboembolism，PTE )적발생。
Objective To investigate the diagnostic values and their respective sensitivities and specificities of D-dimer ( DD ), plasma fibrinogen ( FIB ) and fibrin degradation products ( FDP ) in the development of lower limb deep vein thrombosis ( DVT ) for the patients treated with total hip arthroplasty ( THA ) during the perioperative period. Methods From June 2008 to June 2012, 168 patients were treated with THA in our Department. The plasma DD, FIB and FDP were tested in all the patients before the operation and at the 1st, 3rd and 7th days after the operation. The color Doppler ultrasound blood flow detector was used to examine the development of lower limb DVT in these patients before the operation and at the 3rd and 7th days after the operation. According to the test results of the color Doppler ultrasound blood flow detector, the patients were divided into the positive DVT group and the negative DVT group. The diagnostic values and their respective sensitivities and specificities of DD, FIB and FDP were analyzed in the development of DVT after THA. Results After the operation, 32 patients ( 19.1%) developed DVT. In the 3 indicators, the areas under the receiver operating characteristic ( ROC ) curve were 81.8%for DD ( P=0.002 ) and 68.4% ( P=0.009 ) for FDP, and for FIB the area was only 56.3% ( P=0.31 ). Conclusions There are diagnostic values for DD and FDP in the development of DVT after THA. However, for FIB the diagnostic value is lower. When the DD and FDP are tested promptly after the operation, DVT can be diagnosed without delay, and pulmonary thromboembolism ( PT ) can be avoided.
