后交叉韧带重建术后下肢深静脉血栓的危险因素

Risk factors of deep vein thrombosis of lower extremities after arthroscopic posterior cruciate ligament reconstruction

[目的]探讨后交叉韧带(posterior cruciate ligament,PCL)损伤患者行膝关节镜下韧带重建术后下肢深静脉血栓(deep venous thrombosis,DVT)发生的主要危险因素。[方法]2014年8月~2018年6月行膝关节镜下PCL重建术的患者86例,根据术后第3 d行双下肢静脉B超是否发现DVT,将患者分为DVT组和非DVT组。分析两组患者中年龄、性别、体重指数(body mass index,BMI)、糖尿病、高血压、吸烟史、凝血相关检验指标与DVT发生的相关性。[结果]86例患者术后有13例发生DVT,总的DVT发生率为15.12%。DVT组年龄显著大于非DVT组(P<0.05),DVT组BMI平均值明显大于非DVT组(P<0.05),DVT组Homans征阳性者和Neuhof征阳性者显著高于非DVT组(P<0.05),术后第3 d实验室检查当日DVT组血清D-二聚体水平显著高于非DVT组(P<0.05)。多因素逻辑回归分析表明,高BMI患者在膝关节镜下PCL重建术后,DVT发生风险显著增加(OR=1.490,95%CI=1.051~2.111,P=0.025);术后血D-二聚体增高的患者出现DVT的风险明显增加(OR=4.817,95%CI=1.349~17.206,P=0.015)。[结论]高BMI及D-二聚体水平是PCL损伤患者行膝关节镜下韧带重建术后DVT发生的危险因素。

[Objective]To explore the main risk factors of deep venous thrombosis(DVT)of lower extremities after knee arthroscopic posterior cruciate ligament(PCL)reconstruction.[Methods]From August 2014 to June 2018,86 patients who underwent knee arthroscopic posterior cruciate ligament reconstruction(PCLR)for PCL rupture were included into this study.Based on whether or not DVT was found on the color doppler ultrasound at 3 days postoperatively,the patients were divided into DVT group and non-DVT group.The factors potentially associated with DVT were searched,including age,gender,body mass index(BMI),history of diabetes,hypertension and smoking,as well as parameters related to coagulation.[Results]Of the 86 patients who received arthroscopic PCLR,13 patients were definitively diagnosed as DVT,accounted for 15.12%.The DVT group proved significantly greater age and BMI,significantly more positive ratios of Homans and Neuhof sings,as well as significantly higher level of D-dimmer at 3 days after operation than the non-DVT group(P<0.05).As results of multiple logical regression,the patients with higher BMI were at higher risk of DVT(OR=1.490,95%CI 1.051~2.111,P=0.025)and those with increased level of D-dimmer achieved more chance of DVT(OR=4.817,95%CI 1.349~17.206,P=0.015).[Conclusion]Increased BMI and postoperative D-dimmer levels are risk factors of DVT following knee arthroscopic posterior cruciate ligament reconstruction for the posterior cruciate ligament injury.