胫骨高位截骨术后下肢深静脉血栓发生相关因素分析

Correlation factor analysis of deep vein thrombosis after high tibial osteotomy

目的探讨胫骨高位截骨术(HTO)后下肢深静脉血栓(DVT)的发生率、发生部位及其影响因素。方法笔者收集自2013-01—2014-12行HTO术治疗的膝关节骨性关节炎伴内翻畸形127例。以术后第3、7 d双下肢深静脉彩色多普勒超声检查是否发现下肢DVT做为诊断依据,统计术后DVT的发生率及栓塞静脉情况,并分析HTO术后下肢DVT的发生与影响因素间的关系。结果 127例中,术后并发DVT 27例,发生率为21.26%。其中肌间静脉16例,腓静脉5例,胫后、腓静脉4例,腘、胫后、腓静脉2例。Logistic回归分析显示:男性与女性(B=-0.710,P=0.043,OR=0.491);止血带时间>90 min与≤90 min(B=1.006,P=0.036,OR=2.736)、BMI>25与≤25(B=1.139,P=0.015,OR=3.125)比较差异有统计学意义,说明性别、止血带时间、BMI是术后DVT发生的独立危险因素;未发现年龄、高血糖、高血脂对DVT发生的影响。结论 HTO术后并发下肢DVT在临床中发生率较高,DVT多发生于肌间、胫后、腓、腘静脉。DVT的发生可能与手术创伤、止血带的使用、术后小腿肿胀、女性、高龄、肥胖等因素有关。

Objective To explore the occurrence rate, occurrence site and influence factor of deep vein thrombosis （DVT） in low extremity after high tibia osteotomy （HTO）. Methods From January 2013 to December 2014, total 127 cases of osteoarthritis of the knee accompanied with varus underwent HTO. All the cases received the Doppler ultrasound examination 3 and 7 days after operation. The occurrence rate, occurrence site and the correlation between the DVT and other influence factor were analyzed with Logistic regression analysis of SPSS 17.0 software. Results Twenty seven cases had DVT after HTO （21.26%） including 16 cases of muscular venous thrombosis, 5 cases of peroneal veins thrombosis, 4 cases of posterior tibial veins and peroneal veins thrombosis and 2 cases of popliteal vein, posterior tibial veins and peroneal veins thrombosis. The logistic regression analysis showed that the statistic differences were significant, male VS female （B =-0.710, P =0.043, OR =0.491）, time with tourniquet 〉90 min VS ≤90 min（B =1.006, P =0.036, OR =2.736）, BMI〉25 VS ≤〈25（B =1.139, P = 0.015, OR =3.125）. The result showed strong correlations of sex, time with tourniquet and BMI with DVT. The effect of age, elevated blood sugar and hyperlipidemia on DVT were not found. Conclusion The occurrence rate of DVT after HTO is high. The common occurrence sites of DVT are venous of calf muscle, posterior tibial veins,fibular vein and popliteal vein. The occurrence of DVT may be correlated with the trauma of operation, the usage of tourniquet, swelling of calf after operation, sex, age and obesity.