人工关节置换术围手术期肌间静脉血栓的形成与转归  

The outcome of muscular vein thrombosis after knee and hip arthroplasty

作　　者：姚尧[1] 邱君斓[2] 乔梁[1] 陈东阳[1] 徐志宏[1] 史冬泉[1] 戴进[1] 薛龙[1] 蒋智明[2] 沈祎[2] 朱澄妍 张炜炜[2] 蒋青[1] 

机构地区：[1] 南京大学医学院附属鼓楼医院运动医学与成人重建外科,210008 [2]南京大学医学院外科超声室,210008

出　　处：《中华骨科杂志》2016年第19期1236-1242,共7页Chinese Journal of Orthopaedics

摘　　要：目的 探讨人工关节置换术围手术期肌间静脉血栓形成的转归及其影响因素.方法 2015年1至12月在接受人工关节置换术住院期间由下肢深静脉彩色超声多普勒确诊的新鲜比目鱼肌肌间静脉血栓患者47例,男6例,女41例;年龄46～92岁,平均（68.3±7.7）岁.膝关节置换36例,髋关节置换11例.通过彩色超声多普勒观察肌间静脉血栓在术后6周及术后3个月的溶解情况.分析年龄（＞ 65岁、≤65岁）、体重指数（＞25 kg/m2、≤25 kg/m2）、性别（男、女）、手术部位（髋、膝）、血栓长度（＞5cm、≤5 cm）、血栓最大直径（＞1cm、≤1 cm）、抗凝时间（出院后延长抗凝、未延长抗凝）、血栓形成时间（术前、术后第1～3天、术后第4天至出院）等因素对术后3个月肌间血栓转归的影响.结果 肌间静脉血栓于术前发现9例,术后第1～3天发现27例,术后第4天以后发现11例.术后6周时44例发生溶解,其中完全溶解19例（40.4％,19/47）、部分溶解25例（53.2％,25/47）,1例（2.1％,1/47）进展至腘静脉,2例（4.3％）无变化.术后3个月时45例发生溶解,其中完全溶解35例（74.5％,35/47）、部分溶解10例（21.3％,10/47）,未见其他部位形成新的血栓,另2例无变化.术后6周和术后3个月血栓完全溶解率比较差异有统计学意义（x2=8.797,P=0.003）.血栓最大直径＞1cm组与≤1cm组术后3个月血栓完全溶解率的差异有统计学意义（x2=12.231,P=0.000）,其他因素不同分组术后血栓完全溶解率的差异无统计学意义.结论 髋、膝关节置换术后绝大部分肌间静脉血栓可随时间推移而逐渐溶解.血栓最大直径对术后3个月肌间静脉血栓的转归有影响,直径＞1cm的血栓在术后3个月内很难完全溶解.Objective To observe the outcome of muscular vein thrombosis after joint arthroplasty and to analyze potential factors that could affect the result.Methods From January 2015 to December 2015,a total of 47 fresh muscular vein thrombosis diagnosed by ultrasound were collected during hospitalization.There were 6 male and 41 female with the average age of 68.3±7.7 years old （46-92 years old）.Among them,36 patients underwent knee arthroplasty,while 11 accepted hip arthroplasty.Sonography was used to evaluate the resolution of muscular vein thrombosis at the time point of 6 weeks and 3 months postoperatively and the results were compared between the two time points.Multivariable analysis was performed to evaluate the relationship between the resolution of DVT 3 months postoperatively and risk factors including age （〉 65/≤65 years old）,Body Mass Index （〉 25/≤25 kg/m2）,gender （male/female）,type of surgery （knee/hip）,maximum length of thrombosis （〉 5/≤5 cm）,maximum diameter （〉 1/≤1 cm）,duration of anticoagulation therapy （extended anticoagulation therapy after discharge/anticoagulation therapy during hospitalization）,time of diagnosis with DVT （before surgery/within 3 days postoperatively/postoperative day 4 to hospital discharge）.Results Nine cases were diagnosed preoperatively,27 cases were found between postoperative day 1 and 3,and 11 cases were found between day 4 and discharge.At 6 weeks postoperatively,44 cases of muscular vein thrombosis were found resolving with 19 cases （40.4%） thoroughly resolvedand 25 cases （53.2%） partly resolved,only 1 case （2.1%） progressed into the popliteal veins,2 cases （4.3%） had no change on the size.At the follow up of 3 months,45 cases were found resolving with 35 cases （74.5%） through resolved and 10 cases （21.3%） partly resolved,no case progressed into proximal veins,2 cases （4.3%） had no change on the size.There was significant difference in thrombosis recanalization between the two time points （x2=

关 键 词：关节成形术 置换 围手术期 静脉血栓形成 超声检查 血栓溶解疗法 

分 类 号：R687.4[医药卫生—骨科学]