髋膝关节置换术前预测深静脉血栓形成的多因素分析

Preoperative multivariate analysis of risk factors for deep vein thrombosis after hip and knee arthroplasty

[目的]通过对髋、膝关节置换术前患者的相关危险因素的分析,个体化预测其术后下肢深静脉血栓形成(deep vein thrombosis,DVT)的可能性。[方法]2006年4月～2011年11月共309例(髋关节病变113人、膝关节病变196人)接受髋、膝关节置换术的无DVT的患者被纳入研究。所有患者在围术期均接受正规的物理及药物预防血栓治疗。术后第3～10 d根据患者病情复查双下肢深静脉彩超了解是否形成血栓。最后,通过术后DVT组与非DVT组的各种术前危险因素的对比分析,提出术前预测术后DVT的公式。[结果]309名患者中术后发生DVT者82例,其中髋关节12例,膝关节70例;单关节置换术后38例,双关节同时置换术后44例。通过判别分析,发现年龄、谷草转氨酶、肌酐、一次手术关节数量、凝血酶原时间和D-二聚体定量与髋、膝关节置换术后DVT的相关性较强,并得出函数预测公式。所有患者平均随访3.5年(4～71个月),均未发生症状性肺栓塞,也未发生明确的肝素类药物副作用。[结论]即使在围术期正规抗凝治疗的前提下,髋、膝关节置换术后DVT的发生率仍然较高。术前如开展个体化预测,能提示对高危人群给予更积极、合理的干预,从而减少术后DVT相关的并发症。

[Objective]To analyze risk factors in a patient＇ s general physical condition and preoperative biochemical examination results,in order to predict the probability of deep vein thrombosis（DVT） after surgery.[Methods]From April 2006 to November 2011,a total of 309 non-DVT patients（113 hip patients,196 knee patients） who would receive hip or knee replacement were enrolled in the study.Peri-operative mechanical and chemical prophylaxis against DVT was regularly prescribed for all the patients.During postoperative day 3 to 10,according to patient recovery,color doppler flow imaging of lower limb vein system was used to detect DVT or not.Thus,all the patients were divided into DVT group and non-DVT group.Finally,a preoperative DVT forecasting formula could be formed by comparative analyses of all the preoperative risk factors in the two groups.[Results]Eighty-two of the total 309 patients were divided into the DVT group,including 12 hip arthroplasty and 70 knee arthroplasty cases.DVT after happened in 38 cases with unilateral joint replacement,while in 44 cases with bilateral joint replacement.Age,number of surgery joint,aspertate aminotransferase,creatinine,prothrombin time and d-dimer were found more correlated with DVT,and a forecasting formula could be brought forward.All the patients were followed up for an average of 3.5 years（4 to 71 months）,no one had symptomatic pulmonary embolism,neither they got obvious side effects of low molecular weight heparin drugs.[Conclusion]Even by regular multimodal prophylaxis,the incidence of DVT after hip or knee arthroplasty is still very high.A kind of preoperative individual forecasting modal,which makes early detection possible,may help us give extra reasonable interventions to DVT high-risk population to reduce or alleviate DVT and related complications.