初次全膝置换术后孤立性小腿肌间静脉血栓的预后研究

Prognosis of isolated muscular calf vein thrombosis after primary knee arthroplasty

目的回顾性分析初次全膝关节置换术后孤立性小腿肌间静脉血栓形成患者,经两种抗凝方案处理后的预后情况及并发症情况,比较这两种抗凝方案的有效性及安全性。方法收集2017年1月至2021年11月在西安交通大学第二附属医院初次全膝关节置换术后诊断为孤立性小腿肌间静脉血栓形成的患者,排除既往长期使用抗凝药物、有血栓病史、术前合并血栓、术后合并下肢其他部位深静脉血栓或确诊肺栓塞、有高出血风险不能使用抗凝药物、或对利伐沙班存在使用禁忌的患者。根据抗凝药物使用时限不同分为两组:3个月抗凝组(抗凝时限3个月)和6周抗凝组(抗凝时限6周),两组均口服利伐沙班20 mg 1次/d。所有病人均随访6个月,时间点为治疗后1、2、6、12和24周,观察血栓的转归情况、伤口及并发症情况。比较这两种抗凝方案对孤立性小腿肌间静脉血栓的有效性和安全性。计量资料两组间比较采用独立样本t检验,计数资料采用卡方检验分析。结果顺利完成随访患者共215例。抗凝3个月组与抗凝6周组相比,两组转归情况结局相似(P>0.05)。经抗凝治疗6周后血栓近端蔓延发生率随着时间延长而降低,血栓溶解率渐升高。6周抗凝组出血发生率低于3个月抗凝组,但两组间差异无统计学意义(均为P>0.05);两组的不良切口发生率分别为4.1%、6.5%,差异无统计学意义(P>0.05)。结论初次全膝关节置换术后发生孤立性小腿肌间静脉血栓的患者,抗凝6周可能已经有足够的有效性和安全性,不需要进行3个月的抗凝。

Objective To retrospectively analyze the prognosis and complications of patients with isolated calf intermuscular venous thrombosis after primary total knee arthroplasty,and to compare the efficacy and safety of the two anticoagulation regimens.MethodsFrom January 2017 to November 2021,patients diagnosed with isolated calf intermuscular venous thrombosis after primary total knee arthroplasty in the Second Affiliated Hospital of Xi'an Jiaotong University were collected.The patients with long-term use of anticoagulants,history of thrombosis,preoperative thrombosis,postoperative deep vein thrombosis in other parts of the lower extremities or with confirmed pulmonary embolism,the patients with high hemorrage risk but could not use anticoagulants or contraindicated to use rivaroxaban were excluded.The enrolled patients were divided into two groups according to the duration of anticoagulants:the three-month anticoagulant group,anticoagulant duration were three months;the six-week anticoagulant group,anticoagulant duration were six weeks.Both the groups were given rivaroxaban 20 mg,one time per day.All the patients were followed up for six months in one,two,six,12 and 24 weeks after the treatment.The outcome of thrombosis,wound and complications were observed and analysed to compare the efficacy and safety of these two anticoagulant regimens for isolated calf intermuscular venous thrombosis.Independent samplettest was used for the measurement data comparison between the two groups,andchi squaretest was used for enumeration data.ResultsA total of 215 patients were successfully followed up.There was no statistically significant difference in the prognosis between the two groups(P>0.05).It could be seen from the outcome data of the two groups that the incidence of proximal thrombosis spread decreased with the prolongation of time after six-week anticoagulation treatment,and the thrombolysis rate increased gradually.The incidence of hemorrage in the six-week anticoagulation group was lower than that in the three-month anticoagulation group,but there was no statistically significant difference between the two groups(allP>0.05).The incidence of wound complications in the two groups was 4.1%and 6.5%respectively,yet the difference was not statistically significant(P>0.05).ConclusionFor patients with isolated calf intermuscular venous thrombosis after primary total knee arthroplasty,six weeks of anticoagulation may be effective and safe,and three months of anticoagulation is not necessary.