高龄老人髋关节置换的高危因素:128例特征  

High risk factors in 128 elderly patients undergoing hip replacement

作　　者：张克云[1] 余黎明[1] 张绪华[1] 林昕[1] 张仁明[1] 刘俊[1] 陈超[2] 王建超[2] 

机构地区：[1]湖南怀化医专附属医院暨怀化市第三人民医院骨科,湖南省怀化市418000 [2]华中科技大学同济医学院同济医院骨科,湖北省武汉市430032

出　　处：《中国组织工程研究》2014年第9期1331-1336,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:髋关节置换后的临床并发症深静脉血栓具有较高的发生率,并且深静脉血栓能够导致危及患者生命安全的肺栓塞以及远端深静脉的功能障碍,因此深静脉血栓出现对于逐渐增多的髋关节置换是一个极大的障碍。目的:观察老年患者全髋关节置换后下肢深静脉血栓的发生情况,筛选下肢出现深静脉血栓的危险因素。方法:对128例髋关节置换老年患者临床资料进行回顾性分析,全部患者在置换前1 d及置换后的第7天分别进行双下肢的彩超检查,将患者下肢是否发生深静脉血栓与临床的可疑因素予以Logistic非条件多因素分析。结果与结论:在置换后的第7天出现下肢深静脉血栓患者共16例,其中女性、全身麻醉、双侧髋关节置换、骨水泥的应用为下肢深静脉血栓出现的显著因素,其P值<0.05,能够导致70岁以上老年患者在实施全髋关节置换后出现深静脉血栓的风险呈显著性增加。Logistic非条件多因素的分析中显示性别、肥胖、骨水泥的使用3个因素在老年患者中深静脉血栓出现的风险倍数依次增加达11.398,3.109,8.925;患者血型为O型的70岁以上老年患者在实施全髋关节置换后出现深静脉血栓的风险则显著降低,在置换后出现深静脉血栓降低至0.186倍,能够被作为出现深静脉血栓的一项保护性因素。BACKGROUND： Deep vein thrombosis after hip replacement has a high incidence rate. Moreover, deep vein thrombosis can induce pulmonary embolism that can endanger patients＇ life and dysfunction of distant deep vein. The appearance of deep vein thrombosis is a great obstacle for the gradually increased hip replacement. OBJECTIVE： To observe the occurrence of deep vein thrombosis of lower limb after total hip replacement in elderly patients, and to screen the risk factors for the occurrence of deep vein thrombosis of lower limbs. METHODS： Clinical data of 128 elderly patients with hip replacement were analyzed retrospectively. All patients were examined with color Doppler ultrasound in double lower limbs at 1 day before replacement and 7 days after replacement. Multifactor unconditional logistic analysis was conducted on clinical related factors and the formation of lower limb deep vein thrombosis. RESULTS AND CONCLUSION： At 7 days after the operation, 16 patients affected deep vein thrombosis of lower limb. The factors for deep vein thrombosis contained female, general anesthesia, bilateral hip replacement and the application of bone cement （P 〈 0.05）. The risk for deep vein thrombosis after total hip replacement significantly increased in elderly patients aged over 70 years. Multifactor unconditional logistic analysis exhibited that the multiple risks of sex, obesity and the use of bone cement in elderly patients with deep vein thrombosis increased to 11.398, 3.109 and 8.925. The patients with a blood type O at the age of over 70 years experienced a decreased risk for deep vein thrombosis after total hip replacement. The occurrence of deep vein thrombosis decreased to 0.186 times after replacement. Blood type O could be considered as a protective factor for the occurrence of deep vein thrombosis.

关 键 词：植入物 人工假体 髋关节置换 深静脉血栓 危险因素 发生率 老年人 

分 类 号：R318[医药卫生—生物医学工程]