Venous Thrombosis Of Lower Extremities Research Articles

Analysis of risk factors of lower extremity venous thrombosis in pediatric patients after surgery for congenital heart disease

Objective To explore the risk factors of puncture- or catheter-related lower extremity venous thrombosis after surgery for congenital heart disease(CHD). Methods A retrospective analysis was performed on 683 children with venipuncture or venous catheterization in the lower extremities who underwent surgery for CHD in Children′s Heart Center Intensive Care Unit, Henan Provincial People′s Hospital from January 2017 to December 2018, and there were 55 children suspected thrombosis, among whom, 26 cases of thrombosis confirmed by ultrasound were included in the thrombosis group, and 29 cases without thrombosis seen by ultrasound were assigned to the control group.A comparative analysis was carried out to see whether there were statistical differences in the possible risk factors between the 2 groups, and the risk factors of puncture- or catheter-related lower extremity venous thrombosis after operation of CHD. Results The incidence of puncture- or catheter-related lower extremity venous thrombosis after surgery for CHD was 3.81% (26/683 cases). The differences between the thrombosis group and the control group in age (62 d vs.92 d), weight [(3.92±0.66) kg vs.(4.61±0.86) kg], CHD postoperative critical score (Vasoactive-Ventilation-Renal score, VVR)[(29.58±15.50) scores vs.(22.14±11.72) scores], peak blood lactate within 24 hours after surgery [(3.59±0.66) mmol/L vs.(1.71±1.13) mmol/L], postoperative blood transfusion[76.9%(20/26 cases) vs.34.5%(10/29 cases)], co-infection[53.8%(14/26 cases) vs.24.1%(7/29 cases)], cyanotic congenital heart disease [84.6%(22/26 cases) vs.34.5%(10/29 cases)] and puncture difficulty[69.2%(18/26 cases) vs.17.2%(5/29 cases)] were statistically significant(all P<0.05). Logistic regression analysis showed postoperative VVR score (OR=0.88, 95%CI: 0.77-0.99, P=0.04), blood lactate peak within 24 hours after surgery (OR=6.62, 95%CI: 1.35-32.46, P=0.02), and cyanotic congenital heart disease (OR=0.04, 95%CI: 0.00-0.63, P=0.04) were risk factors for venous thrombosis in the lower extremities. Conclusions High postoperative VVR score, high 24 h blood lactate peak after surgery and cyanotic congenital heart disease are high risk factors for puncture- or catheter-related lower extremity venous thrombosis after surgery for CHD. Key words: Congenital heart disease; Lower extremity vein; Thrombosis; Infant

Preventive effects of early functional exercise and health education nursing intervention guided by health belief model on lower extremity deep venous thrombosis after hip and knee joint replacement in middle-aged and elderly patients

Objective To evaluate the preventive effects of early functional exercise and health education nursing intervention guided by health belief model on deep vein thrombosis(DVT)in middle-aged and elderly patients with hip and knee joint replacement. Methods A total of 98 patients who underwent hip and knee arthroplasty were included in the study.They were divided into two groups according to the randomized principle of the block, with 49 patients in each group.The control group only received routine postoperative care, while the observation group applied early functional exercise and health education model as the guiding health education model.The effects of two groups of different nursing applications were evaluated. Results The disease-related knowledge awareness scores and hip-knee joint function scores of the observation group were higher than those of the control group, and the differences were statistically significant(P<0.05). The incidence of deep venous thrombosis was lower than that of the control group, and the difference was statistically significant(P<0.05). Conclusions Early functional exercise combined with health belief model guided by hip and knee joint replacement in middle-aged and elderly patients can effectively prevent postoperative deep venous thrombosis of lower extremity, and its clinical application value is significant. Key words: Early functional exercise; Health belief model; Health education; Lower extremity deep venous thrombosis

Early diagnosis of intermuscular venous thrombosis of lower extremity after gynecological operation

Due to the particularity of pelvic anatomical structure, intermuscular venous thrombosis of lower extremity is very easy to form after gynecologic surgery.After thrombosis, it can migrate and diffuse, leading to fatal pulmonary embolism or sequelae of thrombosis after organization.Seriously, it will threaten patients' health and quality of life.How to evaluate and diagnose early is especially vital.In this article, the early diagnosis of intermuscular venous thrombosis of lower extremity after gynecologic surgery was summarized.Mainly from the aspects of high risk factors, application of risk assessment scale, clinical manifestations, auxiliary examination and so on., it was briefly analyzed. Key words: Venous thrombosis; Lower extremity; Gynecologic surgical procedures; Diagnosis

Effects of a fast track surgery nursing program in perioperative care of older patients with a hip fracture.

The nursing concept has changed from being "disease centered" to "patient centered". The aim of this study was to explore the clinical effects of a fast track surgery nursing program in the perioperative care of older patients with a hip fracture. Total of 84 patients with hip fracture who were hospitalized in our department were randomly divided into the conventional group (42 cases) and fast track surgery group (42 cases) to compare the psychological state, pain degree, serum inflammatory factors, coagulation, hip function, and incidence of deep venous thrombosis of lower extremities between the groups before and after the nursing program. There were no significant differences between groups as measured by a self-rating anxiety scale, self-rating depression scale, visual analogue score, IL-6, IL-10, TNF-α, coagulation factor level, or Harris score between groups before nursing (P > 0.05). The self-rating anxiety scale, self-rating depression scale, visual analogue score, IL-6, IL-10, TNF-a, coagulation factor level, and deep venous thrombosis in fast track surgery group after nursing were significantly lower than in the conventional group, and the Harris score was significantly higher (P < 0.05). The fast track surgery nursing program can effectively alleviate adverse emotions and pain of patients with a hip fracture, reduce inflammation, improve coagulation and hip function after operation, and reduce the incidence of deep venous thrombosis after operation.

3:45 PM Abstract No. 180 Single-session treatment of lower extremity venous thrombosis using a novel thrombectomy device: results of a pilot study

To study the efficacy of the Jeti thrombectomy device in patients with acute DVT. 30 patients (10 male, 20 female) with mean age of 57 years (± 21 years) with acute lower extremity venous thrombosis were reviewed. The study was approved by the Institutional Review Board (IRB). The primary outcome measure was technical success, defined as reestablishment of inline flow. Secondary outcome measures were percent thrombus removal, total thrombolytic dose, total number of DVT-related procedures, total procedural time, overnight thrombolysis post procedure, ICU length of stay, total hospital length of stay, procedure-related complications. Additional data points included mean symptom duration and venous segments treated. A total of 40 procedures were performed in 30 patients. Technical success was 93.3% (28 of 30 patients). Mean percent thrombus removal was 74.0% (± 28.2%). Mean tPA dose was 7.8 mg (± 8.9 mg). Average number of DVT procedures was 1.3 (± 0.5). Mean procedural time was 88.7 mins (± 44.6 mins). 23 of 30 patients did not require overnight thrombolysis after Jeti thrombectomy. 12 of 30 patients did not require thrombolytics at all. Mean hospital length of stay was 4.9 days (± 5.2 days). Mean ICU length of stay was 1.6 days (± 4.6 days). In the patients who did not require overnight thrombolysis, mean percent thrombus removal was 81.2% (± 24.2%), mean tPA dose was 3.1 mg (± 3.8 mg) and mean ICU length of stay was 1.1 days (± 4.9 days). No major complications were observed. One minor complication included focal contrast extravasation, which was self-limiting. Mean symptom duration was 7.7 days (± 9.2 days). Venous segments included iliocaval (25), iliofemoral (20), femoropopliteal (15). The Jeti aspiration thrombectomy system offers a safe and feasible adjunct to currently available options for peripheral thrombectomy, allowing for significant potential reduction of thrombolytics and ICU length of stay. Further studies to evaluate the safety, efficacy, and cost-effectiveness of the system in the peripheral vasculature are warranted.

Meta-Analysis of Randomized Controlled Trials of Xueshuantong Injection in Prevention of Deep Venous Thrombosis of Lower Extremity after Orthopedic Surgery.

Objective To systematically evaluate the clinical efficacy of Xueshuantong injection (Panax notoginseng saponins) in preventing deep venous thrombosis (DVT) of lower extremity after orthopedic surgery. Methods The randomized controlled trials (RCTs) of Xueshuantong injection in prevention of lower extremity DVT after orthopedic surgery were retrieved from CNKI, Wanfang database, VIP, PubMed, and Cochrane Library by August 2020. Revman5.2 was used to analyze the results. Results A total of 20 articles including 2336 patients were included. The results of meta-analysis showed that the incidence of DVT in the experimental group was lower than that in the control group; after operation, the D-dimer (Ddimer), thrombin time (APTT), and prothrombin time (PT) in the experimental group were significantly improved compared with those in the control group, and the difference between the two groups was statistically significant. Conclusion Xueshuantong injection can effectively prevent the formation of lower extremity DVT after orthopedic surgery and antagonize the postoperative hypercoagulable state of blood, which has high clinical value.

Recurrent Venous and Arterial Thrombosis By Prothrombin p.R596Q Heterozygous Mutation in a Chinese Patient: A Case Report and Literature Review

Objective: To investigate the causes of recurrent thrombosis in a young Chinese patient and review the related literature. Methods: To review the patient's medical history, routine imaging and laboratory testing (including anticoagulant protein activity), and extract DNA of peripheral blood from the patient to detect gene mutation of 76 coagulation and thrombosis-related genes using Hi-Q™ Sequencing. The positive results were amplified by PCR and verified by Sange sequencing, and the related literature was reviewed. Results: The male patient, 23 years old, was hospitalized on April 6th, 2018 because of "repeated chest pain, hemoptysis and asthma for 7 days". The patient underwent thrombolysis in the local hospital in 2015 because of deep vein thrombosis in the right lower extremity. In 2016, he took warfarin orally for intracranial venous sinus thrombosis for one year, and stopped taking the medicine 2 months before this admission. He Had a history of chronic hepatitis B. There was no inducements for the above symptoms before admission. Chest CT examination on April 3th showed that there were infection foci in the lower lobe of the right lung, sub-pleural shadow in the middle lobe of the right lung and the lingual lobe of the left lung, and bilateral pleural adhesion was possible. Pulmonary CTA showed that there were filling defects in the main trunk of both pulmonary arteries. There was no abnormality in the arteriovenous vessels of both lower extremities by B-mode ultrasonography. Chest CT scan after transferred to our hospital showed inflammation and a few strings in both lungs, pericardial effusion: widening of pulmonary artery, bilateral pleural effusion with local expansion of lower lung tissue. D-dimer was 27.59 mg/L. After diagnosed as pulmonary thrombosis, pulmonary infection and chronic viral hepatitis B, the patient was treated with "Rivaroxaban 10mg Bid" for anticoagulation, symptomatic anti-infection and reducing pulmonary artery pressure. Relevant examinations after admission indicated that there were no obvious abnormalities in blood routine , biochemical testing, autoantibody, ANCA and sputum culture. C-reactive protein was 93.6 mg/L, blood homocysteine homocysteine level was within normal range, and multicolour B ultrasonography indicated the formation of venous thrombosis in the right lower extremity. Fibrinogen: 4.9g/l, D-dimer: 14.64mg/L; Antithrombin activity: 94.2%, Protein S activity: 89.1%, Protein C activity: 90%. From April 14th, he was treated with 0.6ml q12h of enoxaparin and from April 24th with warfarin . Because of swelling of the right lower extremity, the right external iliac artery and the right lower extremity venous thrombosis were detected by mutilcolour B ultrasonography on April 26th. The patient refused to undergo IVC filter implantation and continued with warfarin anticoagulation therapy. During hospitalization, all exon regions and lateral intron regions of 76 genes closely related to coagulation and thrombosis diseases were sequenced using Ion PI™ Hi-Q™ Sequencing 200 Kit. The results indicated that prothrombin (NM000506) exon 14 c.1787G &gt; A heterozygous missense mutation resulted in p.R598Q. The presence of this mutation was confirmed by PCR amplification of patient's DNA. Both SIFT database and Polyphen2 database predicted that the mutation site might affect protein function; the p. R596Q mutation was detected in a 60-year-old male patient with deep venous thrombosis (PMID: 23265743). R598 is a highly conserved amino acid, which participates in the formation of prothrombin Na + ion binding ring. R598Q causes conformational changes, keeping thrombin in enzymatic activity, and increases the risk of thrombosis (PMID: 29382582). Conclusion: The heterozygous mutation of prothrombin p. R596Q is the molecular pathological cause of the recurrent multiple site venous and artery thrombosis in this young Chinese patient. The mutation is reported firstly in China. Disclosures No relevant conflicts of interest to declare.

Feasibility study of Kirschner wire-fixation-cortical bone technique in treatment of intertrochanteric fracture

To explore the feasibility and effectiveness of maintaining the reduction of unstable intertrochanteric fractures by Kirschner wire-fixation-cortical bone technique. Forty patients with intertrochanteric fracture [AO/Orthopaedic Trauma Association (AO/OTA) type 31-A2.2] admitted between May 2015 and January 2017 and requiring closed reduction and proximal femoral nail antirotation (PFNA) were randomly divided into trial group (intraoperative Kirschner wire-fixation-cortical bone technique group, 20 cases) and control group (conventional treatment group, 20 cases). There was no significant difference in general data of gender, age, side, body mass index, cause of injury, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, and intraoperative fluoroscopy times of the two groups were recorded; the reduction quality of fracture was observed according to the corresponding relationship between medial and anterior cortex (positive, neutral, and negative support) of intraoperative fluoroscopy proposed by ZHANG Shimin, and the stability of internal fixation and fracture healing were observed; Harris score was used to evaluate the recovery of hip function at 12 months after operation. In the trial group, 6 cases (30%) had 2 Kirschner wires implanted less than 4 times, 7 cases (35%) had 5-8 times, and 7 cases (35%) had 9 times or more. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05), but the blood transfusion volume and intraoperative fluoroscopy times in the trial group were significantly less than those in the control group ( P<0.05). Both groups were followed up 13-21 months, with an average of 17 months. There was no complications such as wound infection, deep venous thrombosis of lower extremities, refracture, and internal fixation-related complications. The quality of intraoperative reduction in the trial group was significantly better than that in the control group ( Z=-2.794, P=0.024). The Harris score of the trial group was significantly better than that of the control group at 12 months after operation ( t=2.98, P=0.01). The use of Kirschner wire-fixation-cortical bone technique during intertrochanteric fracture closed reduction and PFNA internal fixation surgery can effectively maintain the reduction effect, reduce the number of fluoroscopy, improve the reduction quality, reduce allogeneic blood input, obtain better hip function, and do not increase the operation time and intraoperative blood loss.

Analysis on risk factors for deep venous thrombosis of lower extremities after hip fracture

Objective To investigate the risk factors of deep venous thrombosis (DVT) of lower extremities after hip fracture and provide reference for the prevention of DVT. Methods A retrospective case-control study was conducted to analyze the clinical data of 167 patients with hip fracture admitted to Daping Hospital of Army Medical University from January 2016 to December 2016, including 75 males and 92 females, aged 18.7-90.3 years [(70.4±17.7)years]. Using the positive results of ultrasound as the standard for confirming the diagnosis of DVT, 79 patients (47.3%) were assigned to the DVT group, and 88 patients (52.7%) to the non-DVT group. Patients' age, gender, body mass index (BMI), smoking history, D-dimer level, osteoporosis, venous thrombosis risk stratification score (RAPT), coronary heart disease, hypertension, diabetes history, anesthesia method (general anesthesia or nerve blocking), type of surgery (joint replacement or internal fixation), operation time were included in the analysis. The correlation between DVT and the above indices was explored through univariate analysis, followed by logistic regression analysis to determine the risk factors of lower extremities DVT after hip fracture. Results The univariate analysis showed that smoking history, D-dimer level, BMI, RAPT score, hypertension, diabetes, coronary heart disease, anesthesia method and operation time were significantly associated with lower extremities DVT after hip fracture. According to the logistics regression analysis, smoking (OR=9.403, P<0.05). D-dimer (OR=0.999, P<0.01), BMI(OR=0.603, P<0.01), RAPT score (OR=0.499, P<0.05), hypertension (OR=28.965, P<0.01), diabetes(OR=6.948, P<0.05), coronary heart disease (OR=17.185, P<0.01), operation time (OR=36.830, P<0.01) were significantly correlated with newly formed lower extremities DVT after hip fracture. Conclusions Smoking, D-dimer level, obesity (BMI≥25 kg/m2), RAPT score, hypertension, diabetes, coronary heart disease and operation time (≥150 minutes) are independent risk factors for lower extremities DVT after hip fracture. D-dimer level detection shows early diagnostic value for hip fracture with DVT. RAPT score can effectively evaluate DVT in trauma patients, thus guiding and preventing the occurrence of DVT. Key words: Hip fractures; Venous thrombosis; Risk factors

Acute multiple cerebral infarction combined with cerebral microhemorrhage in Polycythemia vera: A case report.

Polycythemia vera (PV) is one of the rare causes of cerebrovascular disease, whose common manifestations in the nervous system are cerebral infarction and transient ischemic attack. A number of cases of PV patients with bleeding complicated with subdural hemorrhage or cerebral hemorrhage have been previously reported. However, sometimes PV patient with complicated cerebral hemorrhage and lower extremity venous thrombosis have been admitted to the People's Hospital of Liaoning Province. The present case study reports on a patient with acute multiple cerebral infarction with cerebral micro-hemorrhage associated with PV, who was not treated with anti-thrombosis treatment. After bloodletting treatment and hydroxyurea treatment, the patients condition was stable and they were discharged. A possible mechanism of infarction is that PV may cause abnormal proliferation of red blood cells, white blood cells and platelets in the circulation, resulting in an increase of blood viscosity and reduction of blood flow velocity. Platelet deficiency may cause abnormal blood coagulation function, which may be the reason for the blood and thrombotic diseases in patients with PV.

Efficacy of low molecular weight heparin in spinal trauma patients after part concentrated screw surgery and its influence on blood parameters and the incidence of deep venous thrombosis

This study was to investigate the efficacy of low molecular weight heparin (LMWH) therapy in patients with spinal trauma after part concentrated screw (PCS) pedicle screw surgery (PSS) and its influence on blood parameters and the incidence of deep venous thrombosis. Prospectively, 36 patients with spinal trauma who underwent PSS were randomly divided into an experimental group (n = 18) and a control group (n = 18). The experimental group was treated with LMWH after the operation. Changes in the vascular endothelial function, inflammatory factors and other blood indexes, and the incidence of deep venous thrombosis in lower extremities were compared between the two groups before and after the surgery. Compared to pre-surgery, the levels of endothelin (ET) and tissue plasminogen activator (tPA) in the experimental group decreased significantly after surgery (all P < 0.001), while the levels of ET increased and tPA decreased significantly in the control group (all P < 0.001). In addition, compared with pre-surgical levels, interleukin-8 (IL-8), IL-6 and procalcitonin (PCT) decreased significantly in the experimental group after surgery while there was a significant increase in these cytokines in the control group (all P < 0.001), with a significant difference in the cytokine levels between the two groups post-surgery (P < 0.01). After the surgery, plasma viscosity, erythrocyte electrophoresis time and platelet aggregation rate in the control group were significantly increased from pre-surgery levels (all P < 0.001), and these levels were also significantly higher than in the experimental group (P < 0.01). The D-dimer (D-D) level in both groups also increased significantly after surgery (all P < 0.001), and the level post-surgery was significantly higher in the experimental group as compared to the control group (P < 0.01). Finally, the incidence of deep venous thrombosis in the experimental group was significantly lower than in the control group (P < 0.05). LMWH is beneficial in reducing the degree of hypercoagulability, hyperviscosity and inflammatory reaction in patients with spinal trauma who underwent PSS. It also effectively reduced the occurrence of deep vein thrombosis in lower limbs after surgery. Thus, it is a candidate for further clinical development.

Consensus among Chinese experts on standard interventional therapy for deep venous thrombosis of lower extremity (second edition)

This is an update on the first edition of the expert consensus. This document discusses the indications and contraindications of interventional treatment methods for deep venous thrombosis such as anticoagulation, catheter-directed thrombolysis, percutaneous mechanical thrombectomy, percutaneous transluminal angioplasty and stent implantation. The operational procedures, considerations, preoperative management, and prevention of complications were also updated, supplemented, and revised. Emphasis is placed on the interventional treatment of acute and subacute deep venous thrombosis to effectively reduce the incidence of post-thrombosis syndrome.

Early diagnosis of pulmonary embolism in patients with skin and soft tissue defects after trauma

Objective: To investigate the early diagnosis method of pulmonary embolism in patients with skin and soft tissue defects after trauma. Methods: From January 2011 to July 2014, 5 patients with skin and soft tissue defects and pulmonary embolism after trauma were admitted to Department of Plastic Surgery and Burns of the Affiliated Drum Tower Hospital of Nanjing University Medical School, including 4 males and 1 female, aged 26-68 years. The medical records of the 5 patients were retrospectively analyzed. Hierarchical screening of patients with suspected pulmonary embolism was performed after admission for 4-45 days. Computed tomography pulmonary angiography (CTPA) was performed immediately in 2 patients who had hemodynamic disorder and were able to tolerate CTPA, and pulmonary embolism was confirmed. Clinical risk assessment was conducted for the other 3 patients who had no obvious hemodynamic disorder and only had clinical manifestations of pulmonary embolism such as chest tightness and dyspnea. Among the 3 patients, two of them were assessed as high risk possibility by clinical risk assessment and diagnosed with pulmonary embolism by CTPA immediately. The other one patient's clinical risk assessment was moderate risk possibility, but D-dimer was positive, and the patient was diagnosed with pulmonary embolism by CTPA immediately. Wound exudation of all patients was collected within 1 week after admission for microbial culture, and wound debridement and skin grafting were performed according to the wound condition. The color Doppler ultrasonography of blood vessel on lower extremity was performed to determine deep venous thrombosis of lower extremity after appearance of symptoms of pulmonary embolism. The patient was immediately given urokinase or recombinant tissue plasminogen activator by intravenous infusion for thrombolysis after definite diagnosis of pulmonary embolism. The activated partial thromboplastin time (APTT) was monitored after treatment, and standardized anticoagulation began when APTT was equal to or lower than 70 seconds. The treatment results of patients, D-dimer measurement value, bed time before definite diagnosis of pulmonary embolism, number of patients underwent wound debridement during hospitalization, definite diagnosis time of pulmonary embolism after wound debridement, and number of patients with deep venous thrombosis of lower extremity and wound infection were recorded. Results: Wounds with skin and soft tissue defects of all patients were completely healed, all skin grafts survived well, pulmonary embolism recovered well after timely treatment, and the trunk and branches of involved pulmonary artery recovered blood supply. The course of disease ranged from 1 month to 3 months. The measurement value of D-dimer was 2.4-31.7 mg/L, and the measurement values of D-dimer of 4 patients were equal to or higher than 5.0 mg/L. The bed time before definite diagnosis of pulmonary embolism was 4-46 days, with an average of 23.2 days. Four patients underwent wound debridement during hospitalization. The definite diagnosis time of pulmonary embolism after the wound debridement was 14-40 days, with an average of 20.5 days. Four patients were diagnosed with deep venous thrombosis of lower extremity. All patients had wound infection, and the bacteria causing wound infection included Pseudomonas aeruginosa of 2 cases, Staphylococcus aureus of 2 cases, and Enterococcus faecalis of 1 case. Conclusions: In the diagnosis process of pulmonary embolism in patients with skin and soft tissue defects after trauma, D-dimer positive, long-term bed rest, experiencing operation during hospitalization, and with deep vein thrombosis and wound infection can be regarded as the key points for diagnosis. When a patient has clinical symptoms of pulmonary embolism and the above conditions, the clinician should promptly perform hierarchical screening, select the corresponding examination to confirm pulmonary embolism, and immediately perform thrombolysis for the patient with pulmonary embolism according to the patient's tolerance, thereby improving patient survival rate.

Effect of preoperative feeding artery occlusion on invasive vertebral hemangioma resection

To evaluate the effectiveness and safety of preoperative feeding artery occlusion on vertebral resection of invasive vertebral hemangioma. The clinical data of 20 patients with invasive vertebral hemangioma who received posterior lumbar vertebral body resection, bone grafting, fusion and internal fixation between March 2010 and March 2017 were retrospectively analyzed. According to whether feeding artery occlusion was performed before operation, the patients were divided into group A (11 cases, tumor feeding artery occlusion before operation) and group B (9 cases, no tumor feeding artery occlusion before operation). There was no significant difference in gender, age, lesion segment, and disease duration between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, blood transfusion volume, and ambulant time after surgery, hospitalization time, and deep venous thrombosis of lower extremities were recorded and compared between the two groups. Pain improvement was evaluated by visual analogue scale (VAS) score. The operation time, intraoperative blood loss, blood transfusion volume, and ambulant time after surgery were significantly less in group A than those in group B ( P<0.05). There was no significant difference in postoperative drainage volume and hospitalization time between the two groups ( P>0.05). Five patients (3 in group A and 2 in group B) suffered from pleural tear due to intraoperative pleural adhesions. Closed thoracic drainage tubes were placed immediately after suture and extubated on 3-5 days. Both groups were followed up 1-1.5 years, with an average of 1.35 years. In group B, 1 patient died of pulmonary embolism at 7 days after operation; and 2 patients developed deep venous thrombosis of lower extremity after operation, who were treated with inferior vena cava filter and thrombolytic therapy, and recovered well after operation. The local pain of the other patients was significantly relieved after operation, and the pain disappeared at 1 month after operation. The VAS scores of the two groups at 3 days after operation were significantly improved when compared with those before operation ( P<0.05). There was no significant difference in VAS scores between the two groups before operation and at 3 days after operation ( P>0.05). Three patients (2 in group A and 1 in group B) who had neurological symptoms were significantly relieved after surgery. Bone healing was achieved in both groups at 1 year after operation. No fracture or loosening of internal fixator occurred during follow-up. Nutritional artery occlusion before vertebrectomy for invasive vertebral hemangioma can effectively reduce intraoperative blood loss, operation time, perioperative blood transfusion, and other perioperative complications.

Efficacy of Catheter-directed Thrombolysis on Post-burn Deep Venous Thrombosis of Lower Extremity.

To observe the clinical effect of catheter-directed thrombolysis on deep venous thrombosis (DVT) of lower extremity after burn. An observational study. Invasive Technology Department, Binzhou City Center Hospital, China, from January 2015 to November 2017. Eighty-two patients with lower extremity DVT after burn were selected as the study object. All patients received catheter-directed thrombolysis and the clinical efficacy was evaluated. The blood coagulation parameters including plasma prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrin original (FIB) and inflammatory response factors including interleukin (IL)-6, C-reactive protein (CRP) and D-dimer were compared before and after treatment. All interventional surgeries that the patients received were successful. The effective rate of catheter-directed thrombolysis was 98.78% (81 cases). After 6 days of treatment, compared with that before treatment, serum PT, APTT and TT were up-regulated (all p <0.001) and FIB was down-regulated (p <0.001). After 6 days of treatment, the levels of serum IL-6, CRP and D-dimer were lower than those before treatment (all p <0.001). No visceral hemorrhage occurred after 1 week of treatment. Catheter-directed thrombolysis of patients with lower extremity DVT after burn produces a good effect. It can improve the coagulation function and reduce the level of inflammatory response factors in patients with high safety.

Correlation between expression and mechanism of imterleukin-1β and related markers in deep venous thrombosis of lower extremities

Objective Verification the changes in expression and mechanism of serum inflammatory factor IL-1 beta and related biomarkers by establishing an animal model of deep vein thrombosis (DVT) in lower extremity of rats. Methods Seventy male SPF SD rates, weighing (200±20) g, randomly divided into groups of ten and made each group of rats equal in weight. Recorded as control group, sham operation group, model experiment 2, 8, 24, 48, 72 h group. The control group was fed normally without any treatment; the sham operation group, laparotomy was performed without vein ligation; the model experimental group was divided into different groups according to different time periods. The model of venous thrombosis of lower extremities was established through venous ligation surgery in rats, they were sacrificed at the 2 hours, 8 hours, 24 hours, 48 hours and 72 hours after the modeling, and blood samples and tissues were collected. The expression levels of IL-1β, tissue factor and xanthine oxidase (XOD) in blood samples of 7 groups of rats were measured by ELISA. DVT morphology were analyzed by Pathology, flow cytometry were used to count peripheral blood circulating endothelial cells in rats separated after injury. The expressions of IL-1β, tissue factor, XOD, pathological and flow results were compared between the normal control group, the sham operation group and the lower extremity deep vein thrombosis model group at different time periods. All data were represented by mean standard deviation (Mean±SD). One-way anova was performed on the measurement data, and the LDS method was used to compare the two pairs. The test level was α=0.05. Results IL-1β, tissue factor, XOD showed no significant difference between the control group and the sham operation group, P>0.05. The model experimental group showed an upward trend in the process of 2 h-24 h and reached a peak value at 24 h. The histopathology showed that red thrombus and mixed thrombus could be seen within 2 h-48 h in the thrombosis model experiment group. The blood vessel wall was accompanied by inflammatory cell infiltration. After 72 h, the thrombus was obviously organized. The CD31 concentration of the control group and the sham operation group were (4.04±1.00), (4.82±1.12), and the difference between the two difference between the two groups was not statistically significant (P<0.05); the CD31 concentration of model experimental group had significant differences from 2 h, (5.188±0.895); 8 h, (5.614±1.243); 24 h, (9.785±1.996); 48 h, (14.198±2.172); 72 h, (18.118±1.025), it continued to increase, P<0.05. Conclusion High expression of inflammatory IL-1β and related markers tissue factor, XOD confirmed the mechanism of injury of deep venous endothelial cells in lower extremities caused by IL-1β and the mechanism of further aggravation of thrombosis after injury. Key words: Venous thrombosis; Interleukins; Inflammation; Circulating enelothelinal cells

Short-term effectiveness of revision total knee arthroplasty with porous-coated metaphyseal Sleeve and MBT implant

To evaluate short-term effectiveness of revision total knee arthroplasty (TKA) with porous-coated metaphyseal Sleeve and MBT implant. A clinical data of 23 patients (24 knees) who underwent revision TKA by using porous-coated metaphyseal Sleeve combined with MBT implant between March 2015 and April 2017 was retrospectively analyzed. There were 8 males (8 knees) and 15 females (16 knees). The age ranged from 48 to 85 years (mean, 65.4 years). The cause of revision TKA included infection in 14 knees, aseptic loosening in 8 knees, instability in 1 knee, and stiff knee in 1 knee. Bone defects were classified according to the Anderson Orthopaedic Research Institute (AORI) bone defect classification. The femoral defect was rated as type ⅡA in 5 knees, type ⅡB in 17 knees, and type Ⅲ in 2 knees; the tibial defect was rated as type ⅡA in 2 knees, type ⅡB in 20 knees, and type Ⅲ in 2 knees. The mean time between primary TKA and revision TKA was 30.6 months (range, 6-86 months). The preoperative range of motion (ROM) was (56.0±24.9)°. The preoperative Hospital for Special Surgery (HSS) total score was 41.9±14.2; and the pain and function scores were 8.5±5.2 and 33.4±13.5, respectively. All patients were followed up 12-39 months (mean, 25.6 months). The mean operation time was 2.2 hours (range, 1.6-2.9 hours). The mean intraoperative blood loss was 580 mL (range, 400-1 000 mL). There were 2 knees (8.3%) of intraoperative fracture associated with Sleeve insertion and 1 knee (4.2%) of acute postoperative infection at 25 days after revision TKA. All incisions healed by first intention. No deep venous thrombosis of lower extremity occurred. X-ray film showed that all implants were stable. At last follow-up, slight discomfort after exercise occurred in 4 knees (16.7%); end-of-stem pain in the tibia occurred in 1 knee (4.2%). The ROM was (114.6±5.1)°, which had significant improvement compared with the preoperative result ( t=11.698， P=0.000). The HSS total score (89.0±10.9), pain score (26.9±6.6), and function score (62.1±5.8) also had significant improvement compared with the preoperative results ( t=15.616, P=0.000; t=12.522, P=0.000; t=10.076, P=0.000). The porous-coated metaphyseal Sleeve combined with MBT implant in revision TKA has a significant improvement in short-term effectiveness and no signs of implant loosening.

Incidence and risk factors of deep venous thrombosis in lower extremity in patients with tibial plateau fracture

Objective To investigate the incidence and risk factors of deep venous thrombosis (DVT) in lower extremity in patients with tibial plateau fracture. Methods The data from 148 patients with tibial plateau fracture were retrospectively analyzed who had been admitted to the Department of Orthopaedic Trauma, Honghui Hospital between September 2014 and December 2017. They were 90 males and 58 females, aged from 19 to 83 years (average, 47.2±13.1 years). According to the Schatzker classification of tibial plateau fractures, 24 cases belonged to type Ⅰ, 17 to type Ⅱ, 25 to type Ⅲ, 29 to type Ⅳ, 34 to type Ⅴ, and 19 to type Ⅵ. The incidence of DVT was detected by venous ultrasound of bilateral lower extremities before and after surgery. The factors related to the occurrence of DVT were statistically analyzed. Univariate analysis was used to determine risk factors, and multivariate logistic regression analysis was used to identify the primary independent risk factors. Results The preoperative DVT incidence was 43.92% (65/148) and the postoperative DVT incidence 52.70% (78/148). Distal thrombus predominated both preoperatively and postoperatively. Age (OR=1.043, 95%CI 1.015~1.072, P=0.002) and D-dimer level upon admission(OR=1.219, 95%CI 1.009~1.473, P=0.040) were independent risk factors for preoperative DVT formation; age (OR=1.075, 95%CI 1.042~1.110, P=0.000), operative time (OR=0.994, 95%CI 0.989~0.999, P=0.016), D-dimer level at 1 day postoperatively (OR=1.135, 95%CI 1.025~1.258, P=0.015) and at 3 days postoperatively (OR=1.366, 95%CI 1.008~1.853, P=0.044) were independent risk factors for postoperative DVT. Conclusions The incidence of DVT in the lower ex-tremity may be high in patients with tibial plateau fracture. Distal thrombus is the main manifestation. In fracture patients, especially the middle-aged and elderly ones, dynamic monitoring of D-dimer level should be combined with lower extremity venous ultrasound for early diagnosis of DVT. In patients with lower extremity DVT, surgical progress should be accelerated on the basis of good surgical quality to reduce the incidence of postoperative lower extremity DVT. Key words: Venous thrombosis; Risk factors; Age factors; D-dimer; Tibial plateau fracture

The Efficacy and Safety of AngioJet Rheolytic Thrombectomy in the Treatment of Subacute Deep Venous Thrombosis in Lower Extremity

The aim of this study is to examine the efficacy and safety of AngioJet rheolytic thrombectomy for the treatment of subacute deep venous thrombosis (DVT) in lower limbs. A retrospective study was performed on 90 patients with subacute DVT (15-90days) in lower limbs in our center from November 2015 to December 2016. In total, 27 patients with subacute DVT in lower limbs treated with AngioJet rheolytic thrombectomy were included in the study, including 17 men and 10 women. The onset time of thrombosis was between 15 and 75days. Five patients were diagnosed bilaterally; 5 patients were diagnosed in the right lower limb; and 17 patients were affected by thrombosis in left lower limb. All the 27 cases received AngioJet rheolytic thrombectomy. After AngioJet thrombectomy, 17 cases were improved to grade II (50-99%), and 10 cases were grade I (<50%). Nineteen cases were treated with subsequent catheter-directed thrombolysis (CDT), and the average time of thrombolysis was 3.2days, with an average urokinase administration dose of 7.32 million units. Among the 27 cases, 21 of them received iliac venous balloon dilation, with 10 of them being implanted with the iliac vein stent; 12 stents were implanted in total. Finally, the angiography suggested that 25 cases (92.6%) obtained a recanalization rate higher than grade II, and no serious complications occurred during the perioperative period. All patients were followed up regularly for 3 to 15months, and 2 patients died from malignant tumor during the follow-up period. Twenty-three cases were followed up for more than 6months; 17 cases finished 12-month follow-up. The primary patency rate at 6 and 12months was 96.3% and 88.9%, respectively. The Villalta score of postoperative postthrombosis syndrome symptom at 6 and 12months was 3.3±2.8 and 3.5±2.8, respectively. It is safe and feasible to use the AngioJet rheolytic thrombectomy in the treatment of subacute DVT in lower limbs. In patients without high risk of bleeding, combination of AngioJet thrombectomy and CDT is an effective treatment to reduce the thrombus volume.

Assessment of deep venous thrombosis in the lower extremity in Behçet's syndrome: MR venography versus Doppler ultrasonography.

Lower extremity venous thrombosis (DVT) is the most common vascular manifestation of Behçet's syndrome (BS). Currently, Doppler ultrasonography (USG) is the most commonly preferred imaging modality in the diagnosis and follow-up of patients with acute and chronic DVT. Magnetic resonance (MR) venography, a quick and a non-invasive imaging modality, is successfully used to detect DVT in various settings. We had been unaware of studies with MR venography in BS. The aim of this study is to compare the diagnostic value of true fast imaging with steady-state precession magnetic resonance (True-FISP MR) venography and Doppler USG in the assessment of chronic DVT among patients with BS. 28 BS patients with chronic lower extremity DVT were studied. Common femoral (CFV) and femoral vein (FV) on both right and left sides were examined for the presence of thrombosis, recanalisation, collaterals and reflux. There are findings of chronic DVT in all Doppler USG images of 28 patients (45 of 56 FV and 35 of 56 CFV), while MR venography detects chronic thrombotic changes in 26/28 (93%) patients (43 of 52 FV and 28 of 52 CFV). Collateral veins are detected in 19 patients (19/28) with MR venography, whereas they are present in only 7 (7/28) with USG (P = 0.003). Furthermore, patients with severe post-thrombotic syndrome are more likely to have collateral formation on the MR compared to those without (12/14 vs 7/14; P = 0.043). Among patients with BS, MR venography might be an alternative or additional method to detect chronic thrombosis in the lower extremities.