间歇性充气加压预防跟腱修复术后深静脉血栓

Intermittent pneumatic compression for prevention of deep vein thrombosis after Achilles tendon repair

摘要:

[目的] 探讨间歇性充气加压 （intermittent pneumatic compression, IPC） 治疗对跟腱修复术后深静脉血栓 （deep vein thrombosis, DVT） 发生的影响。[方法] 回顾性分析 2020 年 1 月—2022 年 1 月本院采用微创手术修复的急性跟腱断裂 114 例。 术后医患沟通，59 例术后常规石膏固定 （常规组），55 例术后常规石膏固定的同时加用 IPC 治疗 （IPC 组）。比较两组术后并发症和 DVT 发生率。[结果]两组患者均顺利完成手术。常规组未出现腓肠神经损伤，IPC 组出现 1 例腓肠神经损伤，考虑术中牵拉所致，经过药物治疗后痊愈，差异无统计学意义（P＞0.05）。常规组有 3 例切口愈合不佳，出现浅表感染，IPC 组有 2 例切口浅表感染，经过局部换药后痊愈，两组患者切口愈合等级差异无统计学意义 （P＞0.05）。超声检查显示，IPC 组术后 2 周 DVT 发率显著低于常规组 （5.5% vs 13.6%, P=0.042），术后 4 周两组间 DVT 的发生率差异无统计学意义 （20.0% vs 25.4%，P= 0.737）。[结论]即使石膏固定状态下，IPC 治疗能够有效降低 DVT 的发生，同时对切口愈合及腓肠神经无明显影响。

Abstract:

[Objective] To investigate the efficiency of intermittent pneumatic compression (IPC) used for prevention of deep vein thrombosis (DVT) after Achilles tendon repair. [Methods] A total of 114 patients received minimally invasive surgical repair for acute Achilles tendon rupture in our hospital from January 2020 to January 2022. Based on postoperative doctor-patient communication, 59 pa- tients received postoperative routine plaster fixation (the conventional group), while the other 55 patients underwent postoperative routine plaster fixation combined with IPC treatment (IPC group). The incidence of postoperative complications and DVT was compared between the two groups. [Results] All patients in both groups were successfully operated on. Sural nerve injury was found in one case of the IPC group, whereas non in the conventional group, which was considered to be caused by intraoperative pulling and recovered after drug treat- ment, without a statistically significant difference between the two groups (P＜0.05). Poor incision healing and superficial infection were not- ed in 3 patients in the conventional group, while 2 cases in the IPC group, which healed well after dressing change, with no statistically sig- nificant difference in incision healing grade between the two groups (P＞0.05). Ultrasonographically, the incidence of DVT in the IPC group was significantly lower than that in the conventional group 2 weeks after surgery (5.5% vs 13.6%, P=0.042), whereas it became not signifi- cantly different between the two groups 4 weeks after surgery (20.0% vs 25.4%, P=0.737). [Conclusion] The IPC treatment does effectively reduce the incidence of DVT, without significant impact on wound healing and sural nerve.