全髋置换术后下肢深静脉血栓形成的风险预测  

Risk prediction of lower extremity deep vein thrombosis after total hip arthroplasty

作　　者：林文韬 冯尔宥 姚志鹏[1] 林达生 钟建元 LIN Wen-tao;FENG Er-yu;YAO Zhi-peng;LIN Da-sheng;ZHONG Jian-yuan(Department ofOrthopedics,Union Hospial,Fujian Medical University,Fuzhou,Fujan 350001,China)

机构地区：[1]福建医科大学附属协和医院骨科,福建福州350001

出　　处：《中国矫形外科杂志》2024年第23期2200-2204,共5页Orthopedic Journal of China

摘　　要：【目的】探讨全髋关节置换术(total hip arthroplasty,THA)后下肢深静脉血栓形成(deep vain thrombosis,DVT)的风险因素。【方法】回顾分析本院骨科2018年6月--2022年6月364例初次THA患者临床资料。依据术后临床与超声检查,将患者分为DVT组和非DVT组,比较两组资料,行二元多因素逻辑回归分析,依据逻辑分析结果构建预测列线图。采用受试者工作特征曲线分析评价列线图的预测效能。【结果】364患者中,72例患者发生DVT,占19.8%;另外292例患者未发生DVT,占80.2%。DVT组年龄、BMI、合并糖尿病、血栓史、手术时间、双侧置换比率和卧床时间均显著大于非DVT组(P<0.05),但是,前者使用抗凝剂的比率显著低于后者(P<0.05)。逻辑分析表明,年龄≥70岁(OR=4.127,95%CI1.712~5.392,P=0.012)、BMI≥28kg/m^(2)(OR=2.916,95%CI1.153~4.124,P=0.063)、糖尿病(OR=2.328,95%CI1.412~4.411,P=0.067)、既往血栓病史(OR=5.270,95%CI1.091~2.559,P=0.011)、手术时间≥120min(OR=3.541,95%CI1.215~4.089,P=0.027)、双侧置换(OR=2.28695%CI1.407~4.531,P=0.034)、术后卧床≥3d(OR=4.427,95%CI1.136~1.973,P=0.023)是DVT发生的危险因素;而使用抗凝药物是DVT发生的保护因素(OR=-2.019,95%CI-1.723~-5.802,P<0.001)。逻辑分析构建列线图预测模型并验证,ROC曲线下面积(AUC)为0.867(95%CI0.711~1.000)。【结论】本研究筛选出高龄、糖尿病、血栓史、手术时间、双侧关节置换、卧床时间是全髋关节置换术后下肢深静脉血栓形成的相关因素,并构建了效果较好的列线图预测模型,可能为防治DVT提供参考。【Objective】To search the risk factors of deep vain thrombosis(DVT)after total hip arthroplasty(THA).【Methods】A retrospective study was conducted on 364 patients who received initial THA in our hospital from June 2018 to June 2022.According to postoperative clinical and ultrasound examination,patients were divided into DVT group and non-DVT group.The data of the two groups were compared,and binary multi-factor logistic regression analysis was performed,and the prediction nomogram was constructed according to the results of logical analysis.The predictive efficiency of the nomogram was evaluated by the receiver operating characteristic curve analysis.【Results】Among 364 patients,72 had DVT,accounting for 19.8%,whereas the other 292 patients did not develop DVT,accounting for 80.2%.The DVT group proved significantly greater than the non-DVT group in terms of age,BMI,diabetes mellitus,history of thrombosis,operation time,bilateral replacement ratio and bed rest time(P<0.05),but the former was significantly less than the latter regarding to the ratio of anticoagulant usage(P<0.05).As results of logical analysis,the age≥70 years(OR=4.127,95%CI 1.712~5.392,P=0.012),BMI≥28 years(0R=2.916,95%CI 1.153~4.124,P=0.063),diabetes mellitus(OR=2.328,95%CI 1.412~4.411,P=0.067),previous history of thrombosis(OR=5.270,95%CI 1.091~2.559,P=0.011),operation time≥120 min(OR=3.541,95%CI 1.215~4.089,P=0.027),bilateral replacement(0R=2.286,95%CI 1.407~4.531,P=0.034),and postoperative bed rest≥3 d(0R=4.427,95%CI 1.136~1.973,P=0.023)were the risk factor for DVT,whereas the use of anticoagulants was a protective factor for DVT(OR=-2.019,95%CI-1.723~-5.802,P<0.001).A nomogram prediction model was created based on the logical regression outcome and verified by ROC with area under curve(AUC)of 0.867(95%CI 0.711~1.000).【Conclusion】In this study,advanced age,diabetes,previous thrombosis,operative time,bilateral joint replacement,and bed rest time were selected as the related factors for deep vein thrombosis after total hip a

关 键 词：全髋关节置换术 深静脉血栓 危险因素 列线图预测模型 

分 类 号：R687.4[医药卫生—骨科学]