CAJ | 학술논문

背景：OCM入路微创小切口全髋关节置换术（THA）创伤小、恢复快，理论上可降低DVT的发生率，但目前尚缺乏术后早期影像学检查判定DVT发生率的确切报道。目的：对行OCM入路微创小切口的全髋关节置换患者进行术后常规深静脉造影检查，以明确其深静脉血栓发生率并指导临床血栓预防。方法：行单侧OCM入路微创小切口THA患者27例，男13例，女14例；年龄28~90岁，平均（63.4±16.4）岁；BMI为21.2~29.8 kg/m2，平均（24.9±2.42）kg/m2；其中股骨头坏死9例，股骨颈骨折7例，发育性髋关节发育不良（DDH）6例，髋关节骨关节炎3例，强直性脊柱炎2例。术后行利伐沙班及气压泵治疗。评估手术时间、手术切口长度、肢体长度差异、术后下地行走时间、术后VAS评分（术后1、3 d）、术中和术后出血情况、术中和术后输血情况。股骨颈骨折患者术前及所有患者术后3~5 d行双下肢深静脉造影，以明确DVT发生情况。结果：手术切口长8~10 cm，平均（8.5±0.6）cm；手术时间为65~125 min，平均（82±13）min；术中出血量为100~350 ml，平均（225±72）ml；术后引流量为120~905 ml，平均（457±218）ml，共4例患者输血。所有患者术后当天即可进行主动屈髋锻炼，双下肢长度差异均＜1 cm，术后1、3 d的VAS评分分别为0~6分，平均（2.5±1.4）分和0~4分，平均（1.9±1.2）分，所有患者术后2~3 d即可站立或行走。术前7例股骨颈骨折患者中2例发现患侧下肢DVT，术后深静脉造影检查仍提示同侧DVT，其余25例患者术后仅1例股骨颈骨折患者提示健侧腓肠肌静脉丛血栓形成。结论：采用OCM微创小切口手术入路THA可明显降低DVT的发生率。
배경：OCM입로미창소절구전관관절치환술（THA）창상소、회복쾌，이론상가강저DVT적발생솔，단목전상결핍술후조기영상학검사판정DVT발생솔적학절보도。목적：대행OCM입로미창소절구적전관관절치환환자진행술후상규심정맥조영검사，이명학기심정맥혈전발생솔병지도림상혈전예방。방법：행단측OCM입로미창소절구THA환자27례，남13례，녀14례；년령28~90세，평균（63.4±16.4）세；BMI위21.2~29.8 kg/m2，평균（24.9±2.42）kg/m2；기중고골두배사9례，고골경골절7례，발육성관관절발육불량（DDH）6례，관관절골관절염3례，강직성척주염2례。술후행리벌사반급기압빙치료。평고수술시간、수술절구장도、지체장도차이、술후하지행주시간、술후VAS평분（술후1、3 d）、술중화술후출혈정황、술중화술후수혈정황。고골경골절환자술전급소유환자술후3~5 d행쌍하지심정맥조영，이명학DVT발생정황。결과：수술절구장8~10 cm，평균（8.5±0.6）cm；수술시간위65~125 min，평균（82±13）min；술중출혈량위100~350 ml，평균（225±72）ml；술후인류량위120~905 ml，평균（457±218）ml，공4례환자수혈。소유환자술후당천즉가진행주동굴관단련，쌍하지장도차이균＜1 cm，술후1、3 d적VAS평분분별위0~6분，평균（2.5±1.4）분화0~4분，평균（1.9±1.2）분，소유환자술후2~3 d즉가참립혹행주。술전7례고골경골절환자중2례발현환측하지DVT，술후심정맥조영검사잉제시동측DVT，기여25례환자술후부1례고골경골절환자제시건측비장기정맥총혈전형성。결론：채용OCM미창소절구수술입로THA가명현강저DVT적발생솔。
Background:Minimally invasive total hip arthroplasty (THA) by anterolateral approach (OCM technique) has small trauma, quick recovery and theoretically low incidence of deep vein thrombosis (DVT). However, the accurate incidence of DVT by radiological examination is still lacking. Objective:To identify the incidence of venographic DVT after THA with OCM technique and to provide guidance for the prevention of thrombus. Methods:TTotally 27 patients (13 males and 14 females) with unilateral OCM technique were enrolled in the study. There were 9 cases with avascular necrosis of femoral head, 7 with femoral neck fracture, 6 with developmental dysplasia of the hip, 3 with osteoarthritis of the hip and 2 with ankylosing spondylitis. The mean age of the patients was (63.4 ± 16.4) years (ranging from 28 to 90 years) and the mean BMI was (24.9 ± 2.42) kg/m2 (ranging from 21.2 to 29.8 kg/m2). Rivaroxaban and intermittent pneumatic compression were used after THA. The operation time, length of incision, discrepancy of lower limb, time for weight-bearing, VAS score at day 1 and day 3 postoperatively, transfusion and blood loss during and after THA were evaluated. The DVT were assessed by bilateral venography in the patients with femoral neck fracture preopera-tively and in all patients 3 to 5 days postoperatively. Results:The mean length of incision was (8.5±0.6) cm (ranging from 8 to 10 cm). The mean operation time was (82±13) min (ranging from 65 to 125 min). 4 patients received transfusion. The blooding loss during was (225±72) ml (ranging from 100 to 350 ml) and the postoperative drainage was (457 ± 218) ml (ranging from 120 to 905 ml). Blood was transfused in 4 pa-tients. Active hip flexion exercise was achieved in all the patients. The discrepancy of lower limb was less than one centime-ter. The mean VAS score on day 1 and day 3 postoperatively was 2.5±1.4 (0 to 6) and 1.9±1.2 (0 to 4). All the patients can afford weight-bearing in 2 to 3 days after THA. Two patients with femoral neck fracture were demonstrated as DVT preoper-atively and postoperatively. Only one of the other 25 patients was diagnosed as DVT postoperatively. Conclusions:OCM technique can significantly decrease the incidence of DVT after THA.