论文部分内容阅读
目的:探讨非骨折人群关节置换术前深静脉血栓（deep vein thrombosis，DVT）的发生率及危险因素。方法:2015年3月至2016年8月，对500例择期行关节置换术的非骨折人群下肢静脉血管术前超声检查结果进行回顾性分析。将所有结果根据术前血栓发生情况分为DVT组和非DVT组，纳入人口学资料、基本病史、手术相关信息、实验室指标等因素，通过单因素及多因素Logistic回归分析评估择期关节置换术前DVT形成的危险因素。结果:术前共发现血栓23例，发生率为4.6%（23/500），发生部位均位于肌间静脉。其中全膝关节置换术前16例（5.6%，16/285）、髋关节置换术前7例（3.3%，7/215）发生血栓。单因素分析发现DVT组的年龄（n t=2.266, n P=0.024）、女性患者例数（n χ2=4.028, n P=0.045）、高血压病史例数（n χ2=7.907, n P=0.005）、D-二聚体≥0.5 μg/ml例数（n χ2=13.171, n P<0.001）均显著高于非DVT组，差异均有统计学意义。多因素分析发现D-二聚体≥0.5 μg/ml[n OR=6.655，95%n CI（1.929，22.960），n P=0.003]和高血压病史[n OR=2.715，95% n CI（1.017，7.250），n P=0.046]是术前DVT形成的独立危险因素。术后检查显示23例DVT患者中，9例在新的部位出现DVT，其中5例出现在对侧肌间静脉，4例出现在邻近肌间静脉。出院后22例（95.7%）术前发生血栓者获得随访，随访时间6周至9个月，平均3.0个月，结果显示7例血栓完全溶解，13例血栓部分溶解，2例血栓无变化。未发现有血栓向近端静脉进展及症状性的肺栓塞发生。n 结论:择期关节置换患者术前DVT发生率约为4.6%，其中D-二聚体≥0.5 μg/ml以及高血压病史是引起术前血栓形成的危险因素。“,”Objective:To explore the incidence and risk factors of preoperative deep vein thrombosis (DVT) of elective total joint arthroplasty (TJA).Methods:Data of 500 patients before TJA from March 2015 to August 2016 who underwent ultrasound surveillance were retrospectively analyzed. All patients were divided into DVT group and non-DVT group according to results of ultrasound. Parameters including demographic data, basic medical history, and surgical information and laboratory indexes were collected. Risk factors were assessed via univariate, multivariate and logistic regression analysis.Results:Preoperative DVT was detected in 23 cases (4.6%, 23/500), all of which occurred in the intermuscular vein with no symptom, and among them there were 16 cases (5.6%, 16/285) before total knee arthroplasty and 7 cases (3.3%, 7/215) before total hip arthroplasty. Univariate analysis showed that age (n t=2.266, n P=0.024), female patients (n χ2=4.028, n P=0.045), history of hypertension (n χ2=7.907, n P=0.005), D-dimer ≥0.5 μg/ml ( n χ2=13.171, n P < 0.001) were significantly higher than those in non-DVT group, and the differences were statistically significant. Multivariate analysis showed that D-dimer ≥0.5 μg/ml [ n OR=6.655, 95%n CI (1.929, 22.960), n P=0.003] and history of hypertension [n OR=2.715, 95% n CI (1.017, 7.250), n P=0.046] were independent risk factors for preoperative DVT. Among them, the thrombus of 14 cases located in the operation side, 6 cases in non-operation side, and 3 cases in bilateral sides. Postoperative ultrasound showed that newly DVT occurred in 9 patients of whom 5 cases located in the contralateral muscular veins and 4 cases in the nearby muscular veins. After discharge, 22 patients (95.7%) with preoperative DVT were further evaluated by ultrasound. The average follow-up time was 3.0 months (range from 6 weeks to 9 months). The results showed that thrombus of 7 cases were completely dissolved, 13 cases were partially dissolved, and 2 cases remained unchanged. Thrombus extensions to proximal veins or symptomatic PE were not found.n Conclusion:The incidence of preoperative DVT in patients with elective joint replacement was about 4.6%, among which D-dimer ≥0.5 μg/ml and history of hypertension were the risk factors for preoperative thrombosis.