人工髋膝关节置换术后症状性静脉血栓栓塞性疾病的危险因素分析  

Analysis of risk factors for symptomatic venous thromboembolism after total hip and knee arthroplasty

作　　者：尹星华 周一新[1] 唐杞衡[1] 宋洋[1] 黄行健[1] 杨德金[1] YIN Xing - hua ZHOU Yi - xin TANG Qi - heng et al(Department of Orthopeadics, Beijing Jishuitan Hospital, Beijing 100035, China)

机构地区：[1]北京积水潭医院矫形骨科,100035

出　　处：《中国矫形外科杂志》2016年第19期1765-1769,共5页Orthopedic Journal of China

基　　金：北京市科技计划课题(编号:D121100004212002)

摘　　要：[目的]分析人工髋、膝关节置换术后症状性静脉血栓栓塞性疾病（venous thromboembolism,VTE）发生的危险因素。[方法]2013年5月～2013年12月行人工髋、膝关节置换术患者602例,这些患者在术后出现下肢疼痛、肿胀、周径发生改变、Homans征阳性时行双下肢深静脉彩超（ultrasonography,USG）检查是否发生下肢深静脉血栓（deep vein thrombosis,DVT）,同时记录入组患者肺栓塞（pulmonary embolism,PE）事件的发生,分析患者年龄、性别、BMI、手术类型、单双侧、糖尿病史、术前血糖、术前胆固醇、术前甘油三酯、术前D-dimer等与症状性VTE发生风险的相关性。[结果]人工髋、膝关节置换术后共发生症状性VTE 19例（3.16%）,其中远端DVT 18例（3.00%）,近端DVT 4例（0.66%）,PE 2例（0.33%）。症状性VTE患者的平均年龄为（66.74±9.04）岁,显著高于其余患者人群（OR=1.065;95%CI=1.001～1.133;P=0.047）。[结论]症状性VTE是人工髋、膝关节置换术后不容忽视的问题,尽管进行常规的预防,其发生率仍不低。年龄是人工髋、膝关节置换术后发生症状性VTE的危险因素。对于年龄大的患者,应进行及时有效的VTE预防措施。[ Objective] To investigate the risk factors for symptomatic venous thromboembolism （VTE） after total hip and knee arthroplasty. [ Methods ] A total of 602 patients undergoing total hip arthroplasty （THA） or total knee arthroplasty （TKA） from May to December, 2013 were included in this study. Uhrasonography of bilateral lower extremities was performed for patients with pain, swelling, circumference change, and positive Homans sign in the lower extremities after operation to detect deep vein thrombosis （DVT） . The cases of pulmonary embolism （ PE ） were also recorded. The association of age, sex, body mass index （BMI） , operation type （ THA or TKA）, joint number （ ipsilateral or bilateral surgery）, a history of diabetes, and preoperative serum levels of glucose, cholesterol, triglyceride, and D - dimer with symptomatic VTE was analyzed. [ Re- suits] Nineteen patients （3. 16%） experienced symptomatic VTE postoperatively, including 18 cases of distal DVT （3.00%）, 4 cases of proximal DVT （0. 66% ）, and 2 cases of PE （0. 33% ） . The age of symptomatic VTE patients was （66. 74 ± 9. 04） years and was significantly higher than the age of other patients, indicating an association between age and symptomatic VTE （OR = 1. 065, 95% CI = 1. 001 - 1. 133, P =0. 047） . [ Conclusion] Patients treated with THA or TKA have a high incidence of symptomatic VTE postoperatively although preventive measures were taken routinely. Old age is a risk factor for symptomatic VTE after THA or TKA. Therefore, timely, effective preventive measures are needed for elderly patients.

关 键 词：人工髋关节置换术 人工膝关节置换术 静脉血栓栓塞性疾病 双下肢深静脉彩超 

分 类 号：R687.4[医药卫生—骨科学]