髋关节置换术患者术前深静脉血栓形成的危险因素及术后血栓形成可能原因分析

Incidence of deep venous thrombosis before hip arthroplasty and possible causes of postoperative thrombosis

目的探讨髋关节置换术术前患者深静脉血栓形成(DVT)的危险因素,以及术后血栓形成可能的原因。方法回顾性分析2015年9月-2019年12月西安市红会医院创伤骨科收治的361例行髋关节置换术患者的临床资料,其中男102例,女259例;年龄范围65~94岁,平均年龄77.2岁。所有患者均给予皮下注射低分子肝素钙预防下肢血栓形成。术前术后都行双下肢深静脉检查。收集记录两组患者的一般资料,包括年龄、性别、是否合并内科疾病(原发性高血压、2型糖尿病、冠心病)、血清学指标、受伤至入院时间、入院至手术时间。采用SPSS 19.0进行统计分析。结果术前108例形成下肢DVT,发病率为29.92%,其中男性26例(24.07%),女性82例(75.93%)。多因素logistic回归分析结果显示:糖尿病(OR=2.127,95%CI:1.134~3.989,P=0.019)、冠心病(OR:1.692,95%CI:1.056~2.713,P=0.029)、受伤至入院时间(OR=1.677,95%CI:1.037~2.712,P=0.035)是老年患者髋关节置换术术期形成DVT的独立危险因素。168例患者术后形成下肢DVT,发病率为46.54%。患者术后下肢DVT的分型:(1)近端血栓2例(1.19%);(2)远端血栓143例(85.12%);(3)混合血栓23例(13.69%)。患者术后下肢DVT形成与下肢骨折侧别的关系:(1)血栓与骨折患肢同侧84例(50.00%);(2)血栓位于骨折患者健侧19例(11.31%);(3)患者双下肢均有DVT发生65例(38.69%)。结论延迟入院>48 h,合并冠心病及糖尿病为DVT形成的危险因素;术前已有且术后未消失的血栓占术后血栓总发病率的48.81%,术后新发血栓占术后血栓总发病率的51.19%。对于股骨颈骨折行髋关节置换术的老年患者,需行术前、术后多次行双下肢超声检查,及时发现血栓变化,做好防治工作。

Objective To investigate the risk factors of deep venous thrombosis in patients before hip arthroplasty,and to explore the possible causes of postoperative thrombosis.Methods The clinical data of 361 patients with hip arthroplasty treated in the Department of Orthopaedic Trauma of Xi′an Honghui Hospital from September 2015 to December 2019 were studied retrospectively,including 102 males and 259 females,aged 65 to 94 years,and the average age was 72.25 years old.All fracture patients were given subcutaneous injection of low molecular weight heparin calcium to prevent lower extremity thrombosis.The deep veins of both lower extremities were examined before and after operation.The general data of the two groups of patients were collected and recorded,including age,sex,whether complicated with medical diseases(essential hypertension,type 2 diabetes,coronary heart disease),serological indexes,time from injury to admission,and time from admission to operation.The software of SPSS 19.0 was used for statistical analysis.Results The incidence of lower limb DVT,before operation was 29.92%,including 26 males(24.07%)and 82 females(75.93%).The results of multivariate logistic regression analysis showed that diabetes mellitus(OR=2.127,95%CI:1.134-3.989,P=0.019),coronary heart disease(OR=1.692,95%CI:1.056-2.713,P=0.029)and the time from injury to admission(OR=1.677,95%CI:1.037-2.712,P=0.035)were independent risk factors for DVT in elderly patients undergoing hip arthroplasty.The incidence of lower limb DVT,after operation was 46.54%.After operation,proximal thrombus were occurred in 2 cases(1.19%),distal thrombus in 143 cases(85.12%),and mixed thrombus in 23 cases(13.69%).Postoperative thrombus was ipsilateral to the fracture limb in 84 cases(50.00%),thrombus was located in the healthy side of the fracture in 19 cases(11.31%),and DVT occurred in 65 cases(38.69%)in both lower limbs.Conclusions Delayed admission longed than 48 hours,coronary heart disease and diabetes mellitus are the risk factors for the formation of DVT.The thrombus that existed before operation and did not disappear after operation accounted for 48.81%of the total incidence of postoperative thrombosis,and the new thrombus accounted for 51.19%of the total incidence of postoperative thrombosis.For the elderly patients with femoral neck fracture undergoing hip arthroplasty,ultrasonic examination of both lower limbs should be performed before and after operation to find the changes of thrombus in time and do a good job of prevention and treatment.