末永 雅子¹, 平賀 真雄², 中村 克也², 坂口 右己², 畠中 尚美¹, 池田 大輔³, 重田 浩一朗⁴

Masako SUENAGA ¹, Masao HIRAGA², Katsuya NAKAMURA², Yuuki SAKAGUCHI², Naomi HATANAKA ¹, Daisuke IKEDA³, Kouichirou SHIGETA⁴

¹霧島市立医師会医療センター臨床検査室, ²霧島市立医師会医療センター放射線室, ³霧島市立医師会医療センター循環器内科, ⁴霧島市立医師会医療センター消化器内科

¹Department of clinical laboratory, Kirishima medical center, ²Department of radiology, Kirishima medical center, ³Department of cardiology, Kirishima medical center, ⁴Department of gastroenterology, Kirishima medical center

キーワード : ultrasonography, deep venous thrombus, D-dimer

目的：下肢の整形外科領域疾患術前の深部静脈血栓症(以下DVT) の発症状況について超音波で検討した. 対象および方法：2004 年4 月から2005 年1 月に当院整形外科へ下肢の手術を目的で入院した129 例のうち, D ダイマーが基準値1.0 μg ⁄ml を超え下肢静脈超音波検査を行った66 例(平均年齢82.5 歳) を対象とした. 観察は両側腸骨静脈末梢からひらめ静脈とし, 血栓の存在は①B モードで静脈内の血栓の有無, ②静脈圧迫法で静脈内腔消失の有無, ③血流誘発法等も併用した血流シグナルの有無で評価した. 結果：66 例中26 例(39.4％) に血栓を認め, その存在部位は膝窩静脈領域1例で残り25 例はひらめ静脈内であった. 受傷側のみ12 例, 両側に10 例, 受傷対側のみ4 例にDVT を認め, 14 例(54％) は受傷対側にも血栓を認めた. 血栓の有無でD ダイマー値を比較すると血栓有りが平均28.8 μg ⁄ml, 血栓無しが平均24.6 μg ⁄ml と有意差は認めず(P＝0.31), 20.0 μg ⁄ml 未満にも13 例(50.0％) に血栓を認めた. 考察：D ダイマーが基準値を超えると約40％の患者にDVT を認めたが, その数値の多寡では血栓の存在予測は難しかった. 血栓はひらめ静脈内に多く, 受傷対側にも54％も存在し, 検査の際には両側の特にひらめ静脈の検索が必要である. 結語：我々が施行したD ダイマーが基準値を超えた症例に対し下肢静脈超音波検査を行なう方法はDVT の存在を検討するために有効である.

Purpose: We studied the prevalence of deep venous thrombus (DVT) in preoperative orthopedic patients who had sustained leg injury. Materials and methods: Subjects of this study were 66 of the 129 adult individuals aged an average of 82.5 years who had been admitted to this institution for treatment of orthopedic disease of the legs from April 2002 through January 2005,those with D-dimer oncentrations in excess of 1.0μg ⁄ml above the normal range. We carried out ultrasonographic examination of deep venous thrombi from the bilateral external iliac vein to the calf muscle veins and evaluated the existence of deep venous thrombi, paying particular attention to (1) presence of thrombus echo in B-mode images, (2) vein compressibility, and (3) absence of blood flow in the affected vein on compression of the muscles of the lower legs. Results: Twenty-six (39.4％) of these 66 patients had deep venous thrombi: In 1 patient, the deep venous thrombus was in the popliteal vein; in the remaining 25, thrombi were found in the veins of the lower legs. Twenty patients had deep venous thrombi in the injured leg; 10, in both legs; and 4, in the leg uninjured leg. Fourteen of 26 patients had deep venous thrombi on the side opposite the site of injury.We found no significant difference in average D-dimer concentration in patients with deep venous thrombi (mean, 28.8μg ⁄ml) and those without these lesions (mean, 24.6 μg ⁄ml). Thirteen of 26 patients with less than 20.0μg ⁄ml of D-dimer had deep venous thrombi. Discussion: Although about 40 percent of patients with D-dimer values above the normal range had deep venous thrombi, their D-dimer values were not associated with the presence of deep venous thrombus. Almost all the patients studied had deep venous thrombi in the veins of their lower legs, and more than 50 percent of these patients had deep venous thrombi on the side opposite the site of injury, indicating that both legs, especially the lower legs, should be screened for deep venous thrombi. Conclusion: Ultrasonographic study of the legs of orthopedic patients with D-dimer concentration above the normal range was useful in evaluating presence of deep venous thrombus.