人工关节置换术后下肢深静脉血栓形成的危险因素相关性分析

The correlation analysis of the risk factors of lower limb deep vein thrombosis after total joint arthroplasty

目的分析人工关节置换患者术后深静脉血栓(deep vein thrombosis,DVT)形成的相关危险因素。方法 2008年2月至2012年9月,114例关节置换患者术前和术后第7天进行双下肢静脉Duplex彩色超声检查,观察DVT的形成情况,根据是否形成DVT,分为DVT组和非DVT组,记录患者的相关临床因素,分析患者的临床因素与术后下肢深静脉血栓形成(DVT)的发生有无相关性。术后采用标准计量的低分子量肝素抗凝。本组男46例,女68例;年龄24～85岁,平均(59.64±8.63)岁。结果术后发生血栓的患者32例,发生概率为28%,其中THA(total hip arthroplasty,THA)15例,发生概率为18.9%,TKA(total kneearthroplasty,TKA)17例,发生概率为48.6%。进行多因素的logistic回归分析表明:年龄≥65岁、TG≥1.7mmol/L、全身麻醉、膝关节置换是关节置换术后DVT发生的危险因素(P<0.05)。结论年龄高、体重大、TG水平升高、膝关节置换、全身麻醉、有家族性VTE史、饮酒史等的患者发生DVT的风险较高。而年龄高、膝关节置换、全身麻醉及TG≥1.7mmol/L则是关节患者术后发生DVT的危险因素,需要引起临床医生的重视。

Objective To analyze the risk factors of lower limb deep vein thrombosis after total joint arthroplasty. Methods From February 2008 to September 2012, color droppler sonography detection were carried out for 114 patients undergoing total joint arthroplasty before operation and 7 days after operation. Patients were divided into deep vein thrombosis （DVT） group and DVT-free group based on the development of DVT after the operation. Detailed perioperative clinical data of the patients was collected. After operation, all the patients were treated with regular low molecular heparin against DVT. Clinical factors were examined perioperatively to analyze their influences on DVT formation after surgery. Of all cases, there were 46 males and 68 females, aged from 24 to 85 years （59.64±8.63 years on average）. Results After operation, 32 cases （28%） developed DVT, including 15 total hip arthroplasty （THA） cases （18.9%） and 17 total knee arthroplasty （TKA） cases （48.6%）. Logistic regression analysis indicated that age older than 65, TG ≥1.7 mmol/L, general anesthesia and TKA were risk factors for the occurrence of DVT after total joint arthroplasty （P〈0.05）. Conclusions Old age, obesity, raised TG level, general anesthesia, TKA, venous thrombus embolism （VTE） family history and alcohol consumption increase the possibility of the occurrence of DVT. Based on this research, age older than 65, TG ≥1.7 mmol/L, general anesthesia and TKA are risk factors for the occurrence of DVT after total joint arthroplasty. Clinicians should pay attention to it.