全膝置换术下肢血栓分布的相关因素分析△

Characteristics and factors related to deep vein thrombosis distribution in low extremity after total knee arthroplasty

摘要:

［目的］探讨初次全膝关节置换术后下肢深静脉血栓（deep vein thrombosis, DVT）形成的解剖分布特点，以及近端静脉血栓形成的危险因素。［方法］ 回顾性分析 2016 年 1 月—2018 年 12 月本院行初次全膝关节置换术的 824 例患者的临床资料，分析其特点，并采用单因素比较及多因素逻辑回归分析下肢深静脉血栓发生的相关因素。［结果］824 例患者中，97 例术后超声检查确诊为 DVT，占 11.77%（97/824）。1 例 CTPA 检查确诊为肺动脉栓塞，占 0.12%（1/824）。术后症状性血栓 40 例，占 41.24%（40/97）；无症状性血栓 57 例，占 58.76%（57/97）。按腘静脉平面分界将血栓划分为两大类，近端 DVT 15 例，占确诊者的 15.46% （15/97）；远端 DVT 82 例，占 84.54%（82/97）。按检测时间点，术后 1 d 检测出 60 例 DVT，占 61.86%（60/97）；术后 3 d，新检测出 37 例，占 38.14%（37/97）。单因素比较表明：近端型患者手术时间和麻醉持续时间显著高于远端型患者（P< 0.05），术前静脉曲张史比率显著高于远端型患者（P<0.05）。但是，两组一般资料、其他合并病史、术前检验结果与围手术期其他资料的差异均无统计学意义（P>0.05）。多因素逻辑回归表明：手术时间长（OR=1.111，95%CI：1.011~1.220，P=0.028）是全膝关节置术后发生近端下肢深静脉血栓的危险因素。［结论］全膝关节置换术后血栓以远端血栓多见。手术时间长是近端血栓形成的危险因素。

Abstract:

[Objective] To explore the anatomical distribution of deep vein thrombosis (DVT) in the low extremity and factors related to the proximal DVT after primary total knee arthroplasty (TKA) . [Methods] A retrospective study was performed on 824 patients who under- went primary total knee arthroplasty in our hospital from January 2016 to December 2018. The anatomic characteristics of the DVT were an- alyzed, while the related factors of lower extremity deep vein thrombosis were analyzed by univariate comparison and multivariate logistic regression. [Results] Of the 824 patients, 97 patients (11.77%) (97/824) were diagnosed of DVT by postoperative ultrasonography. One case (0.12%) (1/824) was diagnosed as pulmonary embolism by CTPA. After operation, there were 40 cases (41.24%) (40/97) of symptomatic thromboses, and 57 cases (58.76%, 57/97) of asymptomatic thromboses. According to whether the DVT involved the popliteal vein or not it was divided into two categories. Of them, 15 patients suffered from proximal DVT, accounting for 15.46% (15/97) , whereas the remaining 82 patients were of distal DVT, accounting for 84.54% (82/97) . In term of detection time point, 60 patients had DVT detected 1 day after operation, accounting for 61.86% (60/97) , while 37 patients had DVT found newly 3 days after operation, accounting for 38.14% (37/97) . As results of univariate comparison, the proximal DVT group had significantly longer operation time and anesthesia time than the distal DVT group (P＜0.05) , and the former had significantly higher ratio of preoperative varicosity than the latter (P＜0.05) . However, there were no significant differences in terms of general documents, preoperative blood tests, and other information related to operation between the two groups (P＞0.05) . As consequences of multivariate logic analysis, the longer operative time (OR=1.111, 95%CI: 1.011~1.220, P=0.028) was an independent risk factor for proximal DVT after total knee arthroplasty. [Conclusion] The distal DVT is the most common type of them after total knee arthroplasty. However, longer operative time is a risk factor for proximal DVT.