加速康复下全膝关节置换后血栓分布及危险因素  

Deep vein thrombosis distribution and risk factors after total knee arthroplasty during enhanced recovery after surgery

作　　者：吴乾 刘凌峰 李立松 陆英杰[1] 周立宇[1] 徐五 黄立新[1] 蒋定华[1] Wu Qian;Liu Lingfeng;Li Lisong;Lu Yingjie;Zhou Liyu;Xu Wu;Huang Lixin;Jiang Dinghua(Department of Orthopedics,First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China)

机构地区：[1]苏州大学附属第一医院骨科,江苏省苏州市215006

出　　处：《中国组织工程研究》2023年第13期2044-2050,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金青年基金(8160922),项目负责人:李立松;苏州市临床重点病种诊疗基金(LCZX201901),项目负责人:黄立新;苏州大学课外学术科研基金(KY20201019B),项目负责人:吴乾。

摘　　要：背景:深静脉血栓是全膝关节置换后常见的并发症之一,近年来围术期加速康复发展迅速,然而目前国内尚缺乏关于全膝关节置换后血栓发生情况及危险因素的大样本研究。目的:探究加速康复流程下骨关节炎患者全膝关节置换后下肢深静脉血栓发生情况,并进一步探究术后深静脉血栓形成的危险因素。方法:选择2016年5月至2021年12月苏州大学附属第一医院收治的膝关节骨关节炎患者1260例,入院后接受单侧全膝关节置换手术,根据术后双下肢静脉彩超结果分为血栓组(n=140)与无血栓组(n=1120)。采用单因素分析分别比较两组间各项指标的差异,最终将可能有意义的指标作为自变量带入行二元多因素逻辑回归分析。结果与结论:①术后发生深静脉血栓患者140例,其中近端型血栓发生率为1.67%,远端型血栓发生率为9.44%;近端型血栓中,38.10%的血栓单纯累及单支静脉,61.90%的血栓累及2支及以上静脉;远端型血栓中,79.83%的血栓累及单支静脉,20.17%的血栓累及2支及以上静脉;②单因素分析结果显示,血栓组合并高血压史、既往存在下肢静脉曲张史以及存在饮酒史的患者比例显著高于无血栓组患者(P<0.05);③二元多因素逻辑回归分析显示,术前合并高血压病史(OR=1.686,P=0.012,95%CI=1.123-2.531)、既往存在下肢静脉曲张史(OR=4.794,P<0.001,95%CI=2.124-10.820)及存在饮酒史(OR=10.733,P<0.001,95%CI=6.942-16.594)是全膝关节置换后发生下肢深静脉血栓的危险因素;④结果表明,在加速康复程序下,尽管近端型血栓发生率不高,但鉴于其常累及2支及以上静脉,在对此类患者进行血栓治疗评价时应引起重视。术前合并高血压病史、既往存在下肢静脉曲张史及存在饮酒史是全膝关节置换后发生下肢深静脉血栓的独立危险因素,因而手术医生应该重点关注患者的一般状况并进行术前优化。BACKGROUND:Deep vein thrombosis is one of the common complications after total knee arthroplasty.In recent years,enhanced recovery after surgery has developed rapidly.However,there is still a lack of large sample studies on the occurrence and risk factors of thrombosis after total knee arthroplasty in China.OBJECTIVE:To explore the occurrence of deep vein thrombosis in the lower extremities after total knee arthroplasty during enhanced recovery after surgery,and to further explore the risk factors for postoperative deep vein thrombosis.METHODS:A total of 1260 patients who underwent unilateral total knee arthroplasty for knee osteoarthritis in the First Affiliated Hospital of Soochow University from May 2016 to December 2021 were retrospectively analyzed.According to the results of postoperative venous ultrasound of the lower limbs,the patients were assigned into thrombosis group(n=140)and non-thrombosis group(n=1120).The differences of various indicators between the two groups were compared by univariate analysis.Finally,the possible meaningful indicators were taken as independent variables into the binary multivariate logistic regression analysis.RESULTS AND CONCLUSION:(1)140 patients suffered from postoperative deep vein thrombosis,of which the incidence of proximal thrombosis was 1.67%,and the incidence of distal thrombosis was 9.44%.In the proximal type,38.10%of the thrombus involved only one vein,and 61.90%of the patients involved two or more veins.Of the distal type,79.83%involved a single vein and 20.17%involved two or more veins.(2)Univariate analysis results showed that the proportion of patients with a history of hypertension,a history of deep vein thrombosis and a history of drinking alcohol in the thrombotic group were significantly higher than those of the non-thrombosis group(P<0.05).(3)Binary multivariate logistic regression analysis showed that a history of preoperative hypertension(OR=1.686,P=0.012,95%CI=1.123-2.531),a history of deep vein thrombosis(OR=4.794,P<0.001,95%CI=2.124-10.820),and a his

关 键 词：骨关节炎 全膝关节置换 加速康复 深静脉血栓 逻辑回归分析 危险因素 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学] R684.3