人工关节置换术后下肢深静脉血栓形成的危险因素分析

目的：探讨下肢深静脉血栓形成的危险因素.方法：对我院接受髋关节置换（THA）或膝关节置换（TKA）的185例患者的临床资料进行回顾性分析,以术后发生下肢深静脉血栓（DVT）的患者58例为DVT组,未发生DVT的127例患者为无DVT对照组.结果：185例关节置换手术患者中DVT发生率为31.4％ （58/185）,其中21例接受THA手术（21/118,17.8％）,37例接受TKA手术（37/67,55.2％）;血栓形成部位：腓肠肌静脉血栓38例,胫后静脉20例.x2检验显示两组年龄≥65岁,人体质量指数（BMI）≥25kg/m2,膝关节置换术,全身麻醉,有静脉血栓栓塞症（VTE）家族史者有显著差异（P＜0.05～＜0.01）;Logistic多因素分析显示年龄（OR=8.352,P=0.006）,BMI （OR=4.639,P=0.011）,麻醉方式（OR=7.345,P=0.008）,手术方式（OR=3.235,P=0.018）,VTE家族史（OR=7.749,P=0.007）均为DVT独立危险因素.结论：为降低关节置换手术的下肢深静脉血栓风险,应注意降低体重,改进麻醉和手术方式.

Analysis of relative risk factors for lower limb deep venous thrombosis after prosthetic replacement for joint

Objective： To explore risk factors of lower limb deep venous thrombosis （DVT）. Methods： Clinical data of 185 patients, who received total hip arthroplasty （THA） or total knee arthroplasty （TKA） in our hospital, were retrospectively analyzed. A total of 58 patients who occurred postoperative lower limb DVT were regarded as DVT group, and another 127 patients who didn＇t occur DVT were treated as non-DVT control group. Results： Incidence rate of DVT was 31.4% （58/185） in 185 patients undergoing prosthetic replacement for joint, including 21 cases re- ceived THA （21/118, 17.8%） and 37 cases received TKA （37/67, 55.2%） ; thrombosis sites： 38 cases with gas- trocnemius muscle venous thrombus and 20 cases with posterior tibia venous thrombus. X2 analysis indicated that there were significant difference between two groups in patients with age ≥65 years, body mass index （BMI） 25kg/m2 , TKA, general anesthesia, family history of venous thromboembolism （VTE）, P〈0.05--〈0.01 ; Logistic multi-factor analysis indicated that age （OR = 8. 352, P = 0. 006）, BMI （OR = 4. 639, P = 0. 011）, anesthetic method （OR= 7. 345, P = 0. 008）, operation method （OR = 3. 235, P = 0. 018） and VTE family history （OR = 7. 749, P = 0. 007） were risk factors for DVT. Conclusion： Patients should lose weight, and anesthesia and opera- tion methods should be improved in order to reduce risk of lower limb DVT in total joint arthroplasty.