膝关节镜日间手术静脉血栓栓塞的发生率及危险因素分析  

Incidence and risk factors of venous thromboembolism in knee arthroscopic day surgery

作　　者：孙官军[1] 李清山[1] 银毅 付维力[2] 彭旭[1] 王子呓 何克 冷雨 李远 SUN Guanjun;LI Qingshan;YIN Yi;FU Weili;PENG Xu;WANG Ziyi;HE Ke;LENG Yu;LI Yuan(Department of Joint Surgery,Suining Central Hospital,Suining,Sichuan 629000,China;Sport Medicine Center,Department of Orthopedics,West China Hospital,Sichuan University,Chengdu,Sichuan 610000,China)

机构地区：[1]遂宁市中心医院关节外科,四川遂宁629000 [2]四川大学华西医院骨科运动医学中心,四川成都610000

出　　处：《安徽医药》2025年第3期524-529,共6页Anhui Medical and Pharmaceutical Journal

基　　金：四川省医学会(恒瑞)科研基金专项科研课题项目(2021HR34)。

摘　　要：目的研究膝关节镜日间手术静脉血栓栓塞(VTE)的发生率,探讨其发生的相关危险因素。方法回顾性研究,连续纳入2022年1月至2023年7月遂宁市中心医院接受单侧膝关节镜日间手术且符合纳入及排除标准的1019例病人,其中男558例,女461例,年龄范围8~74岁。术前彩超排除下肢静脉血栓,术后第1天复查下肢血管超声后出院,如有血栓则转诊血管外科。根据术后超声将病人分为VTE组和非VTE组,统计术后VTE发生率,采用单因素及二元多重logistic回归分析VTE发生的危险因素。结果1019例日间手术病人中128例12.56%(128/1019)出现VTE。其中肺栓塞1例0.10%(1/1019),近端深静脉血栓(DVT)病人4例0.39%(4/1019),远端DVT病人123例12.07%(123/1019)。术后分析结果显示,女性、年龄增大、胆固醇增高、高脂血症、脑梗死病史、下肢静脉曲张、手术时间长、手术术式是影响发生血栓的独立危险因素(OR>1)。相较于关节清理术,关节镜腘窝囊肿切除术,前交叉韧带(ACL)重建术,后交叉韧带(PCL)重建术病人发生血栓的概率明显升高,其OR值分别为45.30,3.62,4.87。结论膝关节镜日间手术后VTE的发生率为12.56%,主要为远端DVT(12.07%)。女性、年龄增大、胆固醇增高、高脂血症、脑梗死病史、下肢静脉曲张、手术时间长、手术方式是发生血栓的危险因素。相较于关节清理术,关节镜腘窝囊肿切除术,ACL重建术和PCL重建术血栓形成风险明显增高。Objective To examine the prevalence of venous thromboembolism(VTE)in knee arthroscopic day surgery and to analyze the related risk factors.Methods A retrospective study was conducted of 1019 patients who underwent unilateral arthroscopic day surgery at Suining Central Hospital from January 2022 to July 2023 and met the inclusion and exclusion criteria of the study.The patient cohort comprised 558 males and 461 females,with ages ranging from 8 to 74 years.Preoperative Doppler ultrasound was conducted to exclude the presence of venous thrombus embolism(VTE)in the lower extremities,followed by postoperative vascular ultrasound examination of the lower limbs on the first day after the surgical procedure.In the absence of VTE,patients were discharged,while those with VTE were referred to vascular surgery for further management.Subsequently,the patients were categorized into either the VTE group or the non-VTE group based on the findings from postoperative ultrasonography,allowing for the calculation of VTE incidence.To identify the risk factors associated with VTE,univariate and multivariate logistic regression analyses were performed on binary outcome variables.Results Among the 1019 patients,128 cases(12.56%,128/1019)developed VTE.This comprised of 1(0.10%,1/1019)case of pulmonary embolism,4(0.39%,4/1019)cases of proximal deep vein thrombosis(DVT),and 123(12.07%,123/1019)cases of distal DVT.Subsequent analysis conducted postoperatively indicated that female gender,advanced age,elevated cholesterol levels(CHOL),presence of hyperlipidemia,history of cerebral infarction,lower extremity varicose veins,longer duration of operation,and the specific surgical procedure performed were identified as independent risk factors for thrombosis(OR>1).Patients who underwent arthroscopic popliteal cyst resection,anterior cruciate ligament(ACL)reconstruction,and posterior cruciate ligament(PCL)reconstruction exhibited a significantly higher likelihood of thrombosis when compared to those who underwent joint debridement,as indicated by

关 键 词：关节镜检查 膝关节 手术后并发症 日间手术 静脉血栓栓塞 危险因素 

分 类 号：R68[医药卫生—骨科学]