人工髋关节翻修术后单剂量应用抗凝药物联合下肢功能锻炼下深静脉血栓的发生情况及危险因素分析  

Incidence and risk factors of deep venous thrombosis following single-dose anticoagulants combined with lower limb functional exercises after revision total hip arthroplasty

作　　者：储诚翰 李宇 穆文博 吐尔洪江·瓦哈甫 邹晨 郭文涛[2] 胥伯勇[2] 曹力[2] CHU Chenghan;LI Yu;MU Wenbo;Tuerhongjiang·Wahafu;ZOU Chen;GUO Wentao;XU Boyong;CAO Li(Department of Joint Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Joint Surgery,the First Affiliated Hospital of Xinjiang Medical University,Key Laboratory of High Incidence Disease Research in Xingjiang(Xinjiang Medical University),Xinjiang Clinical Research Center for Orthopeadics,Urumqi 830054,China;Department of Burn,Plastic,and Trauma Reconstructive Surgery,Luoyang Center Hospital,Luoyang 471000,China;Pharmacy College of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]中山大学附属第一医院关节外科,广州510080 [2]新疆医科大学第一附属医院关节外科,新疆地区高发疾病研究教育部重点实验室(新疆医科大学),新疆骨科疾病临床医学研究中心,乌鲁木齐830054 [3]洛阳市中心医院烧伤整形创伤修复外科,河南洛阳471000 [4]新疆医科大学药学院,乌鲁木齐830054

出　　处：《中华骨与关节外科杂志》2024年第12期1075-1081,共7页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金地区科学基金(82260435);新疆维吾尔自治区自然科学基金青年基金(2021D01C331)。

摘　　要：目的:探究人工髋关节翻修术后单剂量应用抗凝药物联合下肢功能锻炼下深静脉血栓(DVT)的发生情况及危险因素。方法:回顾性分析2018年6月至2022年6月新疆医科大学第一附属医院行人工髋关节翻修术并在术后接受单剂量抗凝药物联合下肢功能锻炼预防DVT的199例患者的临床资料,根据术后是否发生DVT分为DVT组46例和无DVT组153例,统计DVT的位置分布、累及静脉支数及导致肺栓塞(PE)的情况,采用单因素分析比较两组患者各项指标的差异,并通过多因素分析探讨DVT的独立危险因素。结果:术后近端DVT发生率3.5%、远端DVT发生率19.6%,DVT主要累及的静脉依次为肌间静脉、胫后静脉、腓静脉、腘静脉、股浅静脉、股总静脉及髂外静脉。近端DVT多累及4支静脉,远端DVT多累及单支静脉。危险因素分析结果显示心血管疾病(OR=2.214,95%CI:1.028~4.769,P<0.05),全髋关节翻修术(OR=4.311,95%CI:1.199~15.502,P<0.05)及三部分组件翻修术(OR=4.280,95%CI:1.096~16.722,P<0.05)是导致DVT发生的独立危险因素。结论:人工髋关节翻修术后单剂量应用抗凝药物联合下肢功能锻炼预防DVT具有一定可行性。在此抗凝方案下,人工髋关节翻修术后小腿肌间静脉血栓发生率最高。心血管疾病、全髋关节翻修术、三部分组件翻修术是该抗凝方案下人工髋关节翻修术后DVT的独立危险因素。Objective:To investigate the incidence and risk factors of deep venous thrombosis(DVT)following single-dose anticoagulants combined with lower limb functional exercises after revision total hip arthroplasty(THA).Methods:A retrospective analysis was conducted on the clinical data of 199 patients who underwent revision THA at the First Affiliated Hospital of Xinjiang Medical University from June 2018 to June 2022.The included patients received single-dose anticoagulants combined with lower limb functional exercises to prevent DVT and were divided into two groups based on the occurrence of DVT postoperatively:the DVT group(46 cases)and the non-DVT group(153 cases).The distributions of DVT location,number of involved venous branches,and progression to pulmonary embolism(PE)were statistically analyzed.Univariate analysis was used to compare the differences in various indicators between the two groups,and multivariate analysis was conducted to explore the independent risk factors for DVT.Results:The incidence of postoperative proximal DVT was 3.5%,while distal DVT was 19.6%.The main veins affected by DVT were,in order,the calf muscular vein,posterior tibial vein,peroneal vein,popliteal vein,deep femoral vein,superficial femoral vein,and external iliac vein.Proximal DVT mainly involved four veins,while distal DVT affected a single vein.The risk factor analysis showed that cardiovascular disease(OR=2.214,95%CI=1.028-4.769;P<0.05),revision THA(OR=4.311,95%CI=1.199-15.502;P<0.05),and three-component revision arthroplasty(OR=4.280,95%CI=1.096-16.722;P<0.05)were independent risk factors for the occurrence of DVT.Conclusions:The use of single-dose anticoagulants combined with lower limb functional exercises after revision THA to prevent DVT is feasible.Under this anticoagulation regimen,the incidence of calf muscular venous thrombosis is the highest.Cardiovascular disease,revision THA,and three-component revision arthroplasty were identified as independent risk factors for DVT after revision THA.

关 键 词：人工髋关节翻修术 深静脉血栓 单剂量 抗凝 功能锻炼 

分 类 号：R687[医药卫生—骨科学]