Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Incidence of Deep Vein Thrombosis after Major Hip Surgery and Diagnostic Value of D-dimer

고관절 대수술 후 심부 정맥 혈전증의 발생 빈도와 D-dimer의 진단적 유용성

Yoo, Myung-Chul;Cho, Yoon-Je;Kim, Kang-Il;Im, Yang-Jin;Cho, Kye-Youl;Ryu, Kyung-Nam
유명철;조윤제;김강일;임양진;조계열;류경남

  • Published : 20060000
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Abstract

Purpose : To evaluate the incidence of deep vein thrombosis (DVT) after major hip surgery along with the efficacy of the D-dimer as a routine noninvasive - screening test for DVT. Materials and Methods : From May 2003 to August 2004, 289 patients who underwent major hip surgery were evaluated prospectively. All the patients underwent B-mode ultrasonography (US) preoperatively, and venography or US on postoperative 7 to 10 days. The D-dimer level was also estimated preoperatively, and at 3 and 7 days after surgery. Results : The preoperative D-dimer level was an average 0.60 ug/ml. DVT was encountered in 29 patients (10.1%) and in 28.9% of those over 60 years of age (p＜0.05). Three days after surgery, the average D-dimer level was 3.82 ug/ml in the DVT positive patients and 2.26 ug/ml in the DVT negative patients. Seven days after surgery, the average D-dimer level in the DVT positive and negative patients was 5.19 ug/ml and 2.89 ug/ml. The most predictable D-dimer level for DVT 3 and 7 days after surgery were 2.585 ug/ml and 3.625 ug/ml, respectively. Conclusion : The overall incidence of DVT in our patients undergoing major hip surgery seemed lower than in Western populations. However, there was a significantly increasing tendency if the development of DVT in the older age group. We also recommend a D-dimer assay at postoperative 7 days as a valuable screening test for detection of DVT.

목 적: 고관절 대수술 후 발생하는 심부 정맥 혈전증의 발생빈도와 D-dimer 검사의 유용성을 검토하여 혈전증 조기진단의 가능성을 알아보고자 한다. 대상 및 방법: 2003년 5월부터 2004년 8월까지 289명의 환자를 대상으로 전향적으로 조사하였다. 모든 환자에서 술전 B-mode 초음파 검사를 시행하였고 술 후 7-10일 사이에 하지 정맥 조영술이나 초음파 검사를 시행하여 혈전증 유무를 판단하였다. D-dimer 검사는 술 전 및 술 후 제3일과 7일에 시행하였다. 결 과: 총 29예(10.1%)에서 심부 정맥 혈전증이 발생하였고, 60세에서 69세 사이에서는 28.8%에서 발생하였다. 술 전 측정한 환자들의 D-dimer 수치는 평균 0.60 ug/ml였으며 술 후 제3일에 DVT (-) 환자군에서 평균 2.26 ug/ml, DVT (+) 환자군에서 평균 3.82 ug/ml였고 술 후 제7일에 각각 평균 2.89 ug/ml, 5.19 ug/ml로 모두 유의하게 증가하였다. 술 후 제3일과 7일에 심부 정맥 혈전증을 예측할 수 있는 최적의 D-dimer 수치는 각각 2.585 ug/ml와 3.625 ug/ml였다. 결론: 한국인에서 고관절 대수술 후 심부 정맥 혈전증은 서양에 비해 발생 빈도가 낮은 양상을 보였으나, 연령이 증가할수록 심부 정맥 혈전증의 발생빈도가 의미 있게 증가하였다. 또한 D-dimer 검사는 술 후 제7일에 3.625 ug/ml를 기준으로 하여 심부 정맥 혈전증의 선별검사로 이용할 수 있을 것으로 사료된다.

Keywords

References

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