术前合并陈旧性肌间静脉血栓对全膝关节置换安全性和疗效的影响  

The effect of preoperative old muscular calf vein thrombosis on the safety and efficacy of total knee arthroplasty

作　　者：王锦文 谈正岗 周皓 杨辉 黄易 范卫民[1] 刘锋[1] Wang Jinwen;Tan Zhenggang;Zhou Hao;Yang Hui;Huang Yi;Fan Weimin;Liu Feng(Department of Orthopaedics,The First Affiliated Hospital of Nanjing Medical University,NanJing 210029,China)

机构地区：[1]南京医科大学第一附属医院骨科,南京210029

出　　处：《中华骨科杂志》2024年第6期381-387,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨术前合并陈旧性肌间静脉血栓对全膝关节置换(total knee arthroplaty,TKA)安全性和疗效的影响。方法回顾性分析2021年9月至2023年3月于南京医科大学第一附属医院接受初次TKA的终末期膝关节骨关节炎患者411例,男89例、女322例,年龄(68.05±5.91)岁(范围50~82岁),体质指数(26.8±3.7)kg/㎡(范围17.4~39.8 kg/m 2)。根据TKA术前是否合并陈旧性肌间静脉血栓分为术前血栓组(47例)和术前无血栓组(364例)。观察术后深静脉血栓形成(deep venous thrombosis,DVT)的临床特点(发生位置和大小)和下肢肿胀情况,记录美国膝关节协会(the American Knee Society,AKS)评分、疼痛视觉模拟评分(visual analogue scale,VAS)和Villalta评分,比较两组的差异。结果所有患者均顺利完成手术,随访时间为(7.4±1.1)个月(范围6~9个月)。术前血栓组96%(45/47)的患者术后发生了DVT,大于术前无血栓组的38.5%(140/364),差异有统计学意义(χ^(2)=55.184,P<0.001)。术前血栓组术后发生DVT的患者中29%(13/45)的DVT位于主干静脉,大于术前无血栓组的9%(12/140),差异有统计学意义(χ^(2)=12.028,P<0.001)。术前血栓组术后发生DVT的患者中51%(23/45)术后血栓≥6 mm,大于术前无血栓组的34%(47/140),差异有统计学意义(χ^(2)=4.454,P=0.035)。术后第3天术前血栓组大腿肿胀率为8.42%±3.50%,术前无血栓组为7.80%±4.12%,差异无统计学意义(t=-0.995,P=0.320)。术后第3天术前血栓组小腿肿胀率为8.14%±3.40%,大于术前无血栓组的5.51%±3.45%,差异具有统计学意义(t=-4.923,P<0.001)。两组患者术后AKS评分均升高,术后3、6个月均大于术前,差异有统计学意义(P<0.05)。两组术前AKS评分的差异无统计学意义(P>0.05),术后3、6个月术前血栓组AKS评分均小于术前无血栓组,差异有统计学意义(P<0.05)。两组患者术后VAS评分均降低,术后3、6个月均小于术前,差异有统计学意义(P<0.05)。两组术前VAS评分的差异无统计学�ObjectiveTo investigate the effect of preoperative old muscular calf vein thrombosis on the safety and efficacy of total knee arthroplasty(TKA).MethodsA total of 411 patients with end-stage knee osteoarthritis who underwent primary TKA in the First Affiliated Hospital of Nanjing Medical University from September 2021 to March 2023 were retrospectively analyzed.There were 89 males and 322 females,aged 68.05±5.91 years(range,50-82 years).The body mass index was 26.8±3.7 kg/m 2(range,17.4-39.8 kg/m 2).The group was divided into a preoperative thrombosis group(47 cases)and a preoperative none-thrombosis group(364 cases)according to whether or not there was a combination of old muscular calf vein thrombosis before TKA.The clinical characteristics(location and size)and lower limb swelling were observed,and the American Knee Society(AKS)score,visual analogue scale(VAS)and Villalta score were recorded to compare the differences between the two groups.ResultsAll patients successfully completed the operation and were followed up for 7.4±1.1 months(range,6-9 months).Postoperative deep venous thrombosis(DVT)occurred in 96%(45/47)of the patients in the preoperative thrombus group,which was greater than the 38.5%(140/364)in the preoperative none-thrombus group,and the difference was statistically significant(χ^(2)=55.184,P<0.001).29%(13/45)of the patients who developed DVT postoperatively in the preoperative thrombus group had DVT located in the main vein,which was greater than the 9%(12/140)in the preoperative none-thrombus group,and the difference was statistically significant(χ^(2)=12.028,P<0.001).51%(23/45)of patients with DVT after operation had thrombosis≥6 mm,which was higher than 34%(47/140)of patients in the preoperative none-thrombus group,and the difference was statistically significant(χ^(2)=4.454,P=0.035).The rate of thigh swelling on postoperative day 3 was 8.42%±3.50%in the group with preoperative thrombus and 7.80%±4.12%in the preoperative none-thrombus group,and the differences were not statistically

关 键 词：骨关节炎 膝 关节成形术 置换 膝 静脉血栓形成 预后 

分 类 号：R687.4[医药卫生—骨科学]