ＭＤＣＴを用いた人工股関節置換術後のＤＶＴ，ＰＥの発生率の検討

概要

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Deep venous thrombosis (DVT) and pulmonary embolism (PE) are serious complications of total hip arthroplasty (THA). We assessed DVT and PE after THA with 64-slice multi-detector row CT (MDCT), which can detect DVT and PE simultaneously within one minute. We examined 114 cases of THA (101 patients) and 11 of revision THA (10 patients) between May 2006 and September 2007. There were 87 women and 14 men. The mean age at operation was 62.6 years (range, 3684 years). All patients used a venous foot pump (VFP) on both legs until walking. Compression stockings were routinely used for 2 weeks after walking, and no drug prophylaxis was performed. At day 7, patients underwent combined MDCT pulmonary angiography and indirect CT venography of the lower limbs, with analysis of results by a radiologist. DVT was revealed by MDCT in 7 patients (6.1%). PE was detected in 5 patients (4.4%). None of these lesions was symptomatic. The incidence of DVT or PE was 8.7% in patients who underwent primary THA and 27% in those who underwent revision THA. A cutoff value of 10.0 µg/ml for the D-dimer on day 7 had high sensitivity (100%) but low specificity (55%) in the diagnosis of DVT. Our incidences of DVT and PE in primary THA were quite low, possibly due to accelerated rehabilitation and usage of the VFP. The D-dimer level under 10 µg/ml on postoperative day 7 appears to be an indicator of lack of occurrence of DVT after THA.
日本関節病学会の論文