胫骨高位截骨术后静脉血栓栓塞的危险因素分析

Analysis of risk factors for venous thromboembolism after high tibial osteotomy

目的探讨胫骨高位截骨术后患者下肢深静脉血栓栓塞(deep venous thromboembolism,DVT)的发生率及相关危险因素。方法回顾性地收集2017年1月至2022年12月期间于河北省优抚医院骨科接受胫骨高位截骨术(high tibial osteotomy,HTO)的患者资料。以术后是否发生DVT进行分组,并对与DVT发生可能相关的因素进行统计学分析,先采用单因素分析筛选危险因素,再采用多因素Logistic回归分析确定主要的危险因素。结果140例患者被纳入该研究,HTO术后DVT的发生率为18.6%。单因素结果显示,BMI、围手术期血红蛋白差、输血、纤维蛋白原水平、D-二聚体水平、红细胞比容,术前、术后VAS评分,术前膝关节损伤和骨关节炎结果评分(knee injury and osteoarthritis outcome score,KOOS)疼痛和术前KOOS日常活动是DVT发生的危险因素。Logistic回归分析表明,BMI(OR=1.776,P=0.001)、红细胞比容(OR=5.171,P=0.040)、纤维蛋白原(OR=3.383,P=0.013)、D-二聚体水平(OR=1.015,P<0.001)是DVT发生的独立危险因素。结论HTO术后静脉血栓栓塞发生率较高,针对肥胖、术中出血较多和术后纤维蛋白原和D-二聚体较高的患者,建议采取相应预防措施,降低术后DVT的发生率。

Objective To investigate the regularity and related risk factors of postoperative deep vein thrombosis(DVT)in patients with high tibial osteotomy.Methods The data of patients who underwent high tibial osteotomy(HTO)in Hebei Youfu Hospital from January 2017 to December 2022 were retrospectively collected.The patients were grouped according to whether or not DVT occurred after operation,and the possible factors related to DVT were statistically analyzed.First,single factor analysis was used to screen for risk factors,and then multi-factor Logistic regression analysis was used to identify the main risk factors.Results All 140 patients were included in the study,and the incidence of thromboembolism after HTO was 18.6%.Single factor showed that BMI,the difference of perioperative hemoglobin,blood transfusion,the level of fibrinogen,D-dimer level,erythrocyte hematocrit,preoperative and postoperative VAS,preoperative KOOS pain and preoperative KOOS daily activities were risk factors for DVT.Logistic regression analysis showed that BMI(OR=1.776,P=0.001),erythrocyte volume(OR=5.171,P=0.040),fibrinogen(OR=3.383,P=0.013)and D-dimer level(OR=1.015,P<0.001)were the risk factors for DVT.Conclusion The incidence of venous thromboembolism after HTO is relatively high.For patients with obesity,more intraoperative bleeding and higher postoperative FIB and D-dimer,it is recommended to take preventive measures of DVT in advance to reduce the incidence of DVT after HTO.