手术前后血小板变化对全膝关节置换术后下肢深静脉血栓形成预测的研究

Prediction of deep venous thrombosis in lower extremities after total knee arthroplasty by preoperative and postoperative platelet changes

目的探讨手术前后血小板变化对全膝关节置换术后下肢深静脉血栓形成的预测意义,以及指导临床早期预测并预防血栓性事件的发生。方法回顾性分析西安交通大学医学院附属红会医院创伤骨科2016年1月-2018年6月采用全膝关节置换术治疗的50例退行性膝骨性关节炎患者资料,男性10例,女性40例,平均年龄65.1岁,年龄范围47~80。根据术后双下肢血管B超检查结果分为无栓组(n=24)和血栓组n=26)。记录两组患者手术前后血小板计数和血红蛋白量,并计算其各自差值,分析两组患者手术前后血红蛋白量差值是否存在统计学意义;同时,检验血小板计数差值与全膝关节置换术后下肢深静脉血栓形成是否具有统计学意义。若两组患者血红蛋白量差值无统计学意义,而血小板计数差值有统计学意义,制作R0C曲线,确定其最佳筛选点。若服从正态分布且方差齐性,对两组患者血小板计数差值和血红蛋白量差值进行独立样本《检验,符合正态分布的计量资料以均数±标准差(Afem±SD)表示。结果无栓组手术前后血小板计数差值为(30.4±14.8)×10^9/L、血栓组手术前后血小板计数差值(53.5±15.2)×10^9/L,两组患者血小板计数差值差异具有统计学意义(P<0.001),血小板计数差值的手术前后最佳筛选点为34.0×10^9/L;无栓组手术前后血红蛋白量差值为(20.8±9.3)g/L、血栓组手术前后血红蛋白量差值为(24.0±10.7)g/L,两组患者血红蛋白量差值差异无统计学意义(P>0.05)。结论手术前后血小板计数差值能够有效预测全膝关节置换术后下肢深静脉血栓形成的发生率,当手术前后血小板计数差值≥34.0×10^9/L时,应尽早预防下肢深静脉血栓形成的发生。

Objective To expl ore the predictive significance of platelet changes on deep venous thrombosis of the lower linibs after total knee replacement,and to guide the eaily clinical prediction and prevent the occurrence of thrombotic events.Methods A retrospective study was conducted of the 50 patients who had been treated by total knee arthroplasty for degenerative knee osteoarthropathy from January 2016 to June 2018 in the Department of Orthopedics and Traumaology,Xi'an Jiangtong University Medical College Red Cross Hospital.There were 10 males and 40 females,aged from 47 to 80 years(average age 65.1 years).According to the results of B ultrasound examination of the lower extremities,the patients were divided into the non einbolic group(24 cases)and the embolic group(26 cases).The platelet counts and hemoglobin levels of the two groups were recorded before and after operation,and their respective differences were calculated.The difference of hemoglobin difference between the two groups was analyzed.At the same time,the difference of platelet count and total knee joint were examined.Whether the deep venous thrombosis of the lower extremity after replacement was statistically significant.If there was no statistical difference in the difference in hemoglobin between the two groups,and the difference in platelet count was statistically significant,the ROC curve was made to determine the optimal screening point.If obeying the normal distribution and the homogeneity of the variance,an independent sample t test was performed on the platelet count difference and the hemoglobin amount difference between the two groups,and the dose data in accordance with the normal distribution was expressed as(Mean±SD).Results The difference of platelet count was(30.4±14.8)×10^9/L in thrombosis group and(53.5±15.2)×10^9/L in thrombosis group.The difference of platelet count between the two groups had statistical significance(P<0.001).The best screening point of platelet count difference was 34.0×10^9/L.The difference of hemoglobin count between thrombosis group and thrombosis group was(20.8±9.3)g/L and(24.0±10.7)g/L,there was no significant difference in hemoglobin between the two groups(P>0.05).Conclusions Preoperative and postoperative platelet count difference can effectively predict the incidence of lower extremity deep venous thrombosis after total knee arthroplasty.When the platelet count difference before surgery M34.0×10^9/L,early prevention of deep venous thrombosis should be avoided.The formation of the occurrence.