藏族人群关节置换术后下肢深静脉血栓发生的时间分布

Time distribution of occurrence of deep venous thrombosis after major joint replacement in Tibetan

[目的]探讨藏族人群在全髋关节置换(THA)和全膝关节置换(TKA)术后下肢深静脉血栓(DVT)的发生率及时间分布特点。[方法]回顾分析2017年3月～2018年3月于本院行全髋关节置换术、全膝关节置换术的藏族患者临床资料,其中THA 70例,TKA 167例。所有患者均于术前、术后第1、3、7、14 d常规行双下肢静脉彩超检查,常规使用抗纤溶药,术后常规抗凝。记录THA、TKA术后第1、3、7、14 d DVT的发生例数,计算血栓发生率,统计血栓新发生率最高的时间点,并比较THA、TKA组间的差异。[结果] THA组术后DVT共15例,发生率为21.43%;TKA组术后DVT共51例,发生率为30.54%。TKA术后血栓发生率较THA高,差异有统计学意义(P<0.001)。THA、TKA术后血栓发生的高峰均在术后第1 d,而TKA术后DVT发生的高峰可延至术后第7 d。THA术后第1、3、7、14 d发生的血栓占总血栓数的比例分别为73.33%、6.67%、6.67%、13.33%;TKA术后第1、3、7、14 d发生的血栓占血栓总数的比例分别为43.14%、19.61%、25.49%、11.76%。两组均未发现症状性DVT和PE病例。[结论]藏族人群关节置换术后DVT的发生率偏高,DVT发生的高峰均在术后第1 d。

[Objective] To explore the incidence and time distribution of deep venous thrombosis(DVT) after total hip arthroplasty(THA) and total knee arthroplasty(TKA) in Tibetan population. [Methods] The clinical data of Tibetan patients who had undergone THA(n=70) and TKA(n=167) in our hospital from March 2017 to March 2018 were retrospectively analyzed. All patients routinely took anti-fibrinolytic drugs and postoperative anticoagulation. The vein color ultrasound examinationson bilateral lower limbs were conducted before operation and at 1, 3, 7 and 14 days after the operation. The number of DVT that occurred on the 1 st, 3rd, 7 th and 14 th days after THA and TKA was recorded to calculate the incidence, and then compared between THA group and TKA group. [Results] There were 15 cases of postoperative DVT in THA group with an incidence of 21.43%,while there were 51 cases of postoperative DVT in TKA group with an incidence of 30.54%. The incidence of DVT in TKA group was significantly higher than that in THA group(P<0.05). The peak of thrombosis occurrence was on the 1 stday after operation in both THA and TKA, while DVT occurrence extended to the 7 thday after operation in the TKA. The number of thrombus occurred on the 1 st, 3 rd, 7 th and 14 th days after operation accounted for 73.33%, 6.67%, 6.67% and 13.33% of the total number of DVT respectively in the THA, correspondingly 43.14%, 19.61%, 25.49% and 11.76% in the TKA. However, no symptomaticDVT and pulmonary embolism happened in any patient of the two groups. [Conclusion] The incidence of DVT after major arthroplasty in Tibetan is relatively high with a peak on the 1 stday after the operation.