创伤性股骨头坏死病人术前临床病史与全髋关节置换术后深静脉血栓的相关性分析  

Association between preoperative clinical history and deep venous thrombosis after hip arthroplasty in patients with traumatic femoral head necrosis

作　　者：应璞 许岳[1] 蒋晓伟[1] 缪逸鸣[1] 薛燚[1] 路通[1] YING Pu;XU Yue;JIANG Xiaowei;MIAO Yiming;XUE Yi;LU Tong(Orthopedics Department,Changshu Hospital Affiliated to Nanjing University of Chinese Medicine,Changshu,Jiangsu 215500,China)

机构地区：[1]南京中医药大学常熟附属医院骨科,江苏常熟215500

出　　处：《安徽医药》2025年第1期137-141,共5页Anhui Medical and Pharmaceutical Journal

基　　金：苏州市科技发展计划指导性项目(SKJYD2021007,SKJYD2021202);苏州市“科教兴卫”青年科技项目(KJXW2020068);常熟市卫健委科技计划项目资助性重点项目(CSWS202118);南京中医药大学常熟附属医院课题(cszyy201910)。

摘　　要：目的研究创伤性股骨头坏死(FHN)病人术前临床病史与全髋关节置换术(THA)后深静脉血栓的相关性。方法回顾性分析2014年8月至2022年5月共172例因创伤性FHN来南京中医药大学常熟附属医院行单侧THA术的病人临床资料。所有病人均在THA术后行常规低分子肝素(LWMH)抗凝,并于术后第3天行双下肢静脉B超检查。按检查结果将病人分成DVT组(男22例,女4例,平均年龄64.35岁)和非DVT组(男102例,女44例,平均年龄62.35岁)。分别比较两组病人术前基本临床病史如既往VTE病史、糖尿病、高血压、冠心病(CHD)等与DVT的具体相关性并通过多变量分析DVT发生的危险因素。结果DVT组中CHD发病率为73.08%(19/26),显著高于非DVT组的31.51%(46/146)。创伤性FHN病人合并CHD[OR=6.63,95%CI:(1.49,29.59),P=0.013]或长期吸烟史[OR=4.58,95%CI:(1.26,16.62),P=0.021]是THA术后DVT的发生危险因素。结论冠心病和吸烟史是创伤性FHN病人行单侧THA术后DVT发生的危险因素,对于此类病人需重视术前疾病控制,同时应规范手术操作以减少术后DVT的发生。Objective To investigate the association of preoperative clinical history and deep venous thrombosis after total hip arthroplasty(THA)in patients with traumatic femoral head necrosis(FHN).Methods The clinical data of 172 patients who received unilateral THA in Changshu Hospital Affiliated to Nanjing University of Chinese Medicine due to traumatic FHN from August 2014 to May 2022 were retrospectively analyzed.All patients received routine anticoagulation with low molecular weight heparin(LWMH)after THA and ultrasound examination of both lower extremity veins was performed on the third day postoperatively.According to examination results patients were divided into the DVT(22 males 4 females an average age of 64.35 years)and the non-DVT group(102 males 44 females an average age of 62.35 years).The specific association between preoperative basic clinical history of patients such as previous history of VTE diabetes hypertension coronary heart disease(CHD)and DVT was compared and the risk factors of DVT were analyzed by multivariate analysis.Results The incidence of CHD in DVT group was 73.08%(19/26),which was significantly higher than 31.51%(46/146)in non-DVT group.Traumatic FHN patients with CHD[OR=6.63,95%CI:(1.49,29.59),P=0.013]or long-term smoking history[OR=4.58,95%CI:(1.26,16.62),P=0.021]were risk factors for DVT after THA.Conclusions Coronary heart disease and smoking history are risk factors for DVT after unilateral THA in patients with traumatic FHN.For such patients,preoperative disease control should be emphasized,and surgical procedures should be standardized to reduce the occurrence of postoperative DVT.

关 键 词：股骨头坏死 全髋关节置换术 深静脉血栓 临床病史 冠心病 

分 类 号：R687.4[医药卫生—骨科学]