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J Arthroplasty:同期双侧关节置换患者肺栓塞风险升高

2014-05-22 佚名 医学界骨科频道

双侧髋膝关节炎患者同期一次性进行双侧的关节置换手术具有减少医疗费用和麻醉风险、缩短住院时间、早期恢复功能等优点,但是进行双侧同期置换手术也会相应增加心血管疾病、伤口感染、消化道溃疡、出血的风险。 既往研究表明同期双侧全髋关节置换会增加术后肺栓塞的发病风险,但是,随着抗凝治疗方法的改进和术后早期康复锻炼深入研究,目前研究表明同期双侧髋关节置换并不会增加肺栓塞的发病率。

双侧髋膝关节炎患者同期一次性进行双侧的关节置换手术具有减少医疗费用和麻醉风险、缩短住院时间、早期恢复功能等优点,但是进行双侧同期置换手术也会相应增加心血管疾病、伤口感染、消化道溃疡、出血的风险【原文下载】

既往研究表明同期双侧全髋关节置换会增加术后肺栓塞的发病风险,但是,随着抗凝治疗方法的改进和术后早期康复锻炼深入研究,目前研究表明同期双侧髋关节置换并不会增加肺栓塞的发病率。

美国纽约特种外科医院的Alyssa M.医生对进行同期双髋关节、双膝关节置换的患者进行了一项回顾性研究,其结果发表在2014年5月的The Journal of arthroplasty杂志。


2011年共有7347例患者进行全髋或全膝关节置换手术,其中36例患者发生院内肺栓塞。3576例患者接受全髋关节置换,6例患者发生肺栓塞,发病率0.17%;194例患者接受同期双髋关节置换,1例患者发生肺栓塞,发病率为0.52%,经统计学分析,两者之间发病率没有显著差异。

3239例患者接受膝关节置换,20例患者发生肺栓塞,发病率0.61%,428例患者接受同期双膝关节置换,8例患者发生肺栓塞,发病率为1.87%,经统计分析,两者之间发病率具有显著差异。

需要注意的是,在作者所在的医院,医生在进行双侧关节同期一次性置换前已经进行了充分的术前评估以排除可能出现手术并发症的风险,但是即便如此,同期双髋/膝关节置换患者术后肺栓塞的发生风险仍较高。

原始出处:

Yeager AM, Ruel AV, Westrich GH.Are bilateral total joint arthroplasty patients at a higher risk of developing pulmonary embolism following total hip and knee surgery?J Arthroplasty. 2014 May;29(5):900-2. doi: 10.1016/j.arth.2013.11.001. Epub 2013 Nov 8.【原文下载】

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1710711, encodeId=d4f51e107113c, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Fri Jul 25 09:20:00 CST 2014, time=2014-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742283, encodeId=1f511e42283c5, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Mon Nov 10 05:20:00 CST 2014, time=2014-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1709106, encodeId=b1d91e091064f, content=<a href='/topic/show?id=cd013896021' target=_blank style='color:#2F92EE;'>#同期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38960, encryptionId=cd013896021, topicName=同期)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dd731593408, createdName=zywlvao, createdTime=Tue Nov 18 22:20:00 CST 2014, time=2014-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=9631, encodeId=fb029631db, content=这个研究虽然样本量比较大,但是是回顾性研究,质量并不高。我们知道,双侧同时置换的患者,本身就是高风险状态,而且手术创伤更大,肺栓塞比例也可能会增加。另外,170多例与3000多例是难以比较的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=191, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat May 31 11:32:00 CST 2014, time=2014-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355861, encodeId=29ca1355861ee, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat May 24 06:20:00 CST 2014, time=2014-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522370, encodeId=3bfe15223e00a, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Sat May 24 06:20:00 CST 2014, time=2014-05-24, status=1, ipAttribution=)]
    2014-11-10 yxch48
  3. [GetPortalCommentsPageByObjectIdResponse(id=1710711, encodeId=d4f51e107113c, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Fri Jul 25 09:20:00 CST 2014, time=2014-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742283, encodeId=1f511e42283c5, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Mon Nov 10 05:20:00 CST 2014, time=2014-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1709106, encodeId=b1d91e091064f, content=<a href='/topic/show?id=cd013896021' target=_blank style='color:#2F92EE;'>#同期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38960, encryptionId=cd013896021, topicName=同期)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dd731593408, createdName=zywlvao, createdTime=Tue Nov 18 22:20:00 CST 2014, time=2014-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=9631, encodeId=fb029631db, content=这个研究虽然样本量比较大,但是是回顾性研究,质量并不高。我们知道,双侧同时置换的患者,本身就是高风险状态,而且手术创伤更大,肺栓塞比例也可能会增加。另外,170多例与3000多例是难以比较的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=191, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat May 31 11:32:00 CST 2014, time=2014-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355861, encodeId=29ca1355861ee, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat May 24 06:20:00 CST 2014, time=2014-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522370, encodeId=3bfe15223e00a, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Sat May 24 06:20:00 CST 2014, time=2014-05-24, status=1, ipAttribution=)]
    2014-11-18 zywlvao
  4. [GetPortalCommentsPageByObjectIdResponse(id=1710711, encodeId=d4f51e107113c, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Fri Jul 25 09:20:00 CST 2014, time=2014-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742283, encodeId=1f511e42283c5, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Mon Nov 10 05:20:00 CST 2014, time=2014-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1709106, encodeId=b1d91e091064f, content=<a href='/topic/show?id=cd013896021' target=_blank style='color:#2F92EE;'>#同期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38960, encryptionId=cd013896021, topicName=同期)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dd731593408, createdName=zywlvao, createdTime=Tue Nov 18 22:20:00 CST 2014, time=2014-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=9631, encodeId=fb029631db, content=这个研究虽然样本量比较大,但是是回顾性研究,质量并不高。我们知道,双侧同时置换的患者,本身就是高风险状态,而且手术创伤更大,肺栓塞比例也可能会增加。另外,170多例与3000多例是难以比较的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=191, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat May 31 11:32:00 CST 2014, time=2014-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355861, encodeId=29ca1355861ee, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat May 24 06:20:00 CST 2014, time=2014-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522370, encodeId=3bfe15223e00a, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Sat May 24 06:20:00 CST 2014, time=2014-05-24, status=1, ipAttribution=)]
    2014-05-31 lovetcm

    这个研究虽然样本量比较大,但是是回顾性研究,质量并不高。我们知道,双侧同时置换的患者,本身就是高风险状态,而且手术创伤更大,肺栓塞比例也可能会增加。另外,170多例与3000多例是难以比较的。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1710711, encodeId=d4f51e107113c, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Fri Jul 25 09:20:00 CST 2014, time=2014-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742283, encodeId=1f511e42283c5, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Mon Nov 10 05:20:00 CST 2014, time=2014-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1709106, encodeId=b1d91e091064f, content=<a href='/topic/show?id=cd013896021' target=_blank style='color:#2F92EE;'>#同期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38960, encryptionId=cd013896021, topicName=同期)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dd731593408, createdName=zywlvao, createdTime=Tue Nov 18 22:20:00 CST 2014, time=2014-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=9631, encodeId=fb029631db, content=这个研究虽然样本量比较大,但是是回顾性研究,质量并不高。我们知道,双侧同时置换的患者,本身就是高风险状态,而且手术创伤更大,肺栓塞比例也可能会增加。另外,170多例与3000多例是难以比较的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=191, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat May 31 11:32:00 CST 2014, time=2014-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355861, encodeId=29ca1355861ee, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat May 24 06:20:00 CST 2014, time=2014-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522370, encodeId=3bfe15223e00a, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Sat May 24 06:20:00 CST 2014, time=2014-05-24, status=1, ipAttribution=)]
    2014-05-24 zhaojie88
  6. [GetPortalCommentsPageByObjectIdResponse(id=1710711, encodeId=d4f51e107113c, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Fri Jul 25 09:20:00 CST 2014, time=2014-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742283, encodeId=1f511e42283c5, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Mon Nov 10 05:20:00 CST 2014, time=2014-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1709106, encodeId=b1d91e091064f, content=<a href='/topic/show?id=cd013896021' target=_blank style='color:#2F92EE;'>#同期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38960, encryptionId=cd013896021, topicName=同期)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dd731593408, createdName=zywlvao, createdTime=Tue Nov 18 22:20:00 CST 2014, time=2014-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=9631, encodeId=fb029631db, content=这个研究虽然样本量比较大,但是是回顾性研究,质量并不高。我们知道,双侧同时置换的患者,本身就是高风险状态,而且手术创伤更大,肺栓塞比例也可能会增加。另外,170多例与3000多例是难以比较的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=191, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat May 31 11:32:00 CST 2014, time=2014-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355861, encodeId=29ca1355861ee, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat May 24 06:20:00 CST 2014, time=2014-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522370, encodeId=3bfe15223e00a, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Sat May 24 06:20:00 CST 2014, time=2014-05-24, status=1, ipAttribution=)]

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