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Register a new userThromboprophylaxis after Primary Total Knee Replacement
التمييع الوقائي بعد تبديل مفصل الركبة البدئي
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يعد معدل الانصمام الوريدي الخثاري غير مقبول دون علاج وقائي، و قد أظهر التصوير الوريدي الظليل أن نسبة الخثار الوريدي العميق بعد تبديل مفصل الركبة يصل إلى 40-84 %، و نسبة الصمة الرئوية تصل إلى 1.5 - 10 % و ذلك دون علاج وقائي . و لكن على الجراحين الموازنة بين الحاجة إلى التمييع الوقائي و الحاجة لتجنب الاختلاطات النزفية. هدف هذا البحث هو دراسة واقع التمييع الوقائي بعد تبديل مفصل الركبة البدئي في مشفى المواساة الجامعي ، بقصد تحسين نتائجنا و التقليل من الاختلاطات.
The rate of venous thromboembolism is unacceptable without prophylaxis. Venographic studies of patients without prophylaxis show that the deep vein-thrombosis rates range from 40-84% after total knee replacement, and rates of pulmonary embolism range from 1.5-10%. Surgeons must balance the need for thromboprophylaxis with the need to avoid bleeding complications. The purpose of this study is to evaluate the status of thrombo prophylaxis after primary total knee replacement in ALMouassat university hospital, and to improve our outcome in future, to get better results and fewer complications.
Artificial intelligence review:
Research summary
تتناول هذه الدراسة موضوع التمييع الوقائي بعد عمليات تبديل مفصل الركبة البدئي في مشفى المواساة الجامعي. تهدف الدراسة إلى تقييم فعالية التمييع الوقائي في تقليل معدلات الخثار الوريدي العميق والصمة الرئوية، مع محاولة تقليل الاختلاطات النزفية. شملت الدراسة 93 عملية تبديل مفصل ركبة أجريت على 80 مريضاً بين عامي 2009 و2010. تم استخدام دواء الإينوكسابارين بجرعة 40 ملغ تحت الجلد قبل وبعد الجراحة، واستمر التمييع لمدة 30 يوماً. أظهرت النتائج أن معدل الخثار الوريدي العميق كان 2.15% ومعدل الصمة الرئوية كان 1.075%. ومع ذلك، كانت نسبة الاختلاطات الجراحية مرتفعة حيث بلغت 17.2%، ونسبة الإنتان العميق كانت 4.3%. أشارت الدراسة إلى نقص في تقييم المرضى قبل الجراحة وغياب دليل إرشادي محدد للتمييع، بالإضافة إلى عدم توفر الأجهزة الوقائية الميكانيكية. خلصت الدراسة إلى ضرورة تقييم المرضى بشكل دقيق قبل الجراحة ووضع خطة تمييع وقائي بناءً على حالة كل مريض على حدة.
Critical review
دراسة نقدية: على الرغم من أن الدراسة قدمت معلومات قيمة حول التمييع الوقائي بعد عمليات تبديل مفصل الركبة، إلا أنها تعاني من بعض النقاط الضعيفة. أولاً، كان هناك نقص في تقييم المرضى قبل الجراحة، مما قد يؤثر على دقة النتائج. ثانياً، لم يتم اتباع دليل إرشادي محدد للتمييع، مما يجعل من الصعب تعميم النتائج. ثالثاً، كانت مدة التمييع أطول من الموصى بها عالمياً، مما قد يزيد من خطر الاختلاطات النزفية. وأخيراً، عدم توفر الأجهزة الوقائية الميكانيكية يعتبر نقصاً كبيراً في الدراسة. من المهم أن يتم تحسين هذه الجوانب في الدراسات المستقبلية للحصول على نتائج أكثر دقة وموثوقية.
Questions related to the research
-
ما هو الهدف الرئيسي من الدراسة؟
الهدف الرئيسي من الدراسة هو تقييم فعالية التمييع الوقائي بعد عمليات تبديل مفصل الركبة البدئي في مشفى المواساة الجامعي وتحسين النتائج وتقليل الاختلاطات.
-
ما هي نسبة حدوث الخثار الوريدي العميق والصمة الرئوية في الدراسة؟
نسبة حدوث الخثار الوريدي العميق كانت 2.15% ونسبة حدوث الصمة الرئوية كانت 1.075%.
-
ما هي الاختلاطات الجراحية التي تم ملاحظتها في الدراسة؟
تم ملاحظة نسبة اختلاطات جراحية عالية بلغت 17.2% ونسبة إنتان عميق بلغت 4.3%.
-
ما هي التوصيات التي خلصت إليها الدراسة؟
خلصت الدراسة إلى ضرورة تقييم المرضى بشكل دقيق قبل الجراحة ووضع خطة تمييع وقائي بناءً على حالة كل مريض على حدة.
References used
Agu 0, Hamilton G, Baker D . Graduated Compression Stockings in the Prevention of Venous Thromboembolism. Br. J. Surg., 1999;86:992-1004
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008; 133(6 Suppl): 381S-435S
Sheppeard H, Henson J, Ward DJ, O'Connor BT . A clinicopathological study of fatal pulmonary embolism in a specialist orthopaedic hospital. Arch. Orthop. and Traumat. Surg., 1981;99: 65-71
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