膝关节镜术后VTE的发生率及其抗凝策略分析

Incidence of Venous Thrombo Embolism(VTE)in Elective Knee Arthroscopy and an Analysis about Its Prophylaxis

目的关节镜术后静脉血栓栓塞症(venous thrombo embolism,VTE)的预防尚无指南及专家共识可遵循,本研究旨在回顾性研究膝关节镜手术患者术后VTE的发病情况,并对其术后VTE的风险因素及预防措施讨论分析。方法本研究为单中心回顾性研究,对我科于2015年1月至2015年12月收治的膝关节镜手术患者进行随访。共收治慢性退行性及低能量创伤性膝关节镜手术患者400例,男性270例,女性130例,年龄(38±15.2)岁。手术均为择期常规手术,手术时间(55±21)min。术后常规应用VTE物理预防措施,不采用抗凝药物预防。术后6周内,根据患者随访时的临床症状、体征决定进一步行血管超声及肺动脉造影检查,分别了解症状性下肢深静脉血栓(deep venous thrombosis,DVT)及肺栓塞(pulmonary embolism,PE)的发病率,并对发生VTE患者的潜在风险因素进行分析评估。结果术后6周内出现症状性DVT 4例,发生率为1%;其中近心端DVT 1例,远心端DVT 3例;无症状性PE发生。在VTE风险因素中,年龄>60岁、手术时间>60min可能增加VTE发生的风险。结论常规慢性退行性及低能量创伤性膝关节镜手术患者术后症状性DVT发生率很低,且主要发生于远心端,不建议对所有关节镜手术患者均采取常规药物抗凝措施。但是,需对膝关节镜手术围术期患者VTE风险因素进行个性化评估、筛查,对存在高风险患者可采取更加积极的抗凝预防措施。

Objective The incidence of symptomatic venous thrombo embolism（VTE）after knee arthroscopy is uncertain.To determine the incidence,anatomical distribution of venous thrombo embolism（VTE）in limbs undergoing elective unilateral knee arthroscopy without active pharmacologic prophylaxis,to quantify the impact of risk factors on its incidence,and to evaluate the necessity of active pharmacologic prophylaxis in patients undergoing arthroscopic surgery.Methods A retrospective cohort study of elective arthroscopic knee procedures during a twelve-month period（January 1,2015 to December 31,2015）was performed in our department of orthopedics.There were 400 patients who had elective arthroscopic knee procedures.270 were male,and 130 were female,with a mean age of（38 ± 15.2）years.The mean duration of the operation was（55 ± 21）minutes.The patients undergoing elective knee arthroscopy received general physical prophylaxis,but did not receive any kind of chemoprophylaxis.During 6 weeks post surgery,all patients having arthroscopy in our institution were routinely examined.Clinical signs of VTE were checked and recorded,and the occurrence of symptomatic deep venous thrombosis（DVT）or pulmonary embolism（PE）within 6 weeks after surgery was identified by duplex ultrasonography or pulmonary arteriography.The general risk factors of VTE were also analyzed.Results During 6 weeks post surgery,symptomatic DVT was detected in 4（1%）patients.Of these,1 was proximal,and 3 were distal.No patient died and no patient presented with clinically suspected PE.The risk of VTE was significantly higher among patients who had a tourniquet applied for more than 60 minutes or older than 60 years.Conclusion The incidence of symptomatic VTE after arthroscopic knee surgery is very low.Routine pharmacological prophylaxis to prevent symptomatic venous thromboembolism is likely not needed in this patient population.Older age and operation time are associated with increased risk.A specific high-risk group for the development of VTE should be identified and received effective prophylaxis.