髋关节置换术后下肢静脉血栓形成的危险因素分析

目的分析老年股骨颈骨折患者行髋关节置换术(THA)后发生下肢深静脉血栓(DVT)的危险因素。 方法分析2017年7月至2019年5月在海南省文昌市人民医院行THA的病例资料。纳入标准：年龄≥ 60岁；脆性骨折；单侧股骨颈骨折；配合功能锻炼，且随访不少于6个月。排除标准：术前1周使用抗凝药物；既往术后感染；合并严重心、肝、肾功能障碍，恶性肿瘤者；患有凝血功能障碍、类风湿、心肌梗死等疾病；既往患有弥散性血管内凝血、血栓疾病史；精神障碍等。根据THA术后30 d内是否并发DVT，将患者分为血栓组和非血栓组。分析2组患者年龄、性别、手术与受伤间隔时间、身体质量指数(BMI)、麻醉方式、术中出血量、活化部分凝血活酶时间(APTT)变化、血浆凝血酶原时间(PT)变化、血浆纤维蛋白原(FG)变化、血浆D-二聚体(DD)变化情况水平，采用多因素logistic回归分析下肢静脉血栓发生的相关因素影响因素。 结果根据纳入、排除标准，共69例患者被纳入本研究，血栓组14例、非血栓组55例。2组患者的年龄(t＝-1.439)、性别构成(P＝0.496)、手术与受伤间隔时间(P＝0.698)、BMI(Z＝-1.806)、术前的凝血指标(APTT：Z＝-1.728，PT：t＝-1.594，FG：Z＝-1.081)，DD：Z＝-1.806)相比较，差异均无统计学意义(P>0.05)。2组患者的麻醉方法(P＝0.278)、术中出血量(Z＝-0.481)、术后2 d APTT变化水平(Z＝-1.179)、术后2 d PT变化水平(Z＝-1.129)等指标的差异无统计学意义(P>0.05)，血栓组的术后2 d FG变化(Z＝-5.663)、DD变化(Z＝-5.745)明显高于非血栓组，且手术耗时(Z＝-4.377)比非血栓组更久(P<0.05)。多因素logistic回归分析结果显示：手术耗时延长、术后2 d FG升高、术后2 d DD升高均为股骨颈骨折THA术后DVT发生的独立危险因素(OR＝4.137、10.105、16.794，均为P<0.05)。 结论THA手术耗时长、术后2 d的FG变化水平、DD变化水平高，发生DVT的可能性高，需引起警惕。据此可对患者采取针对性治疗方法，减少DVT的发生，改善患者预后。

Risk factors of deep venous thrombosis in lower extremity after hip arthroplasty

ObjectiveTo summarize the risk factors of deep venous thrombosis (DVT) in elderly patients with femoral neck fracture after total hip replacement (THA). MethodsTo analyses of patients with THA in Wenchang People′s Hospital of Hainan Province from July 2017 to may 2019. Inclusion criteria: age≥60 years old, fragility fracture, unilateral femoral neck fracture, ability of cooperation for functional exercises, and the follow-up time was no less than six months. Exclusion criteria: use of anticoagulant drugs within one week before operation, previous postoperative infection, severe dysfunctions of heart, liver or kidney, and malignant tumor, coagulation dysfunction, rheumatoid disease, myocardial infarction and other similar diseases, previous history of thrombosis and disseminated intravascular coagulation, mental disorder, etc. The patients were divided into the thrombus group and the non-thrombus group according to whether DVT occurred within 30 d after THA. Age, gender, interval between operation and injury, body mass index (BMI), anesthesia method, intraoperative blood loss, activated partial thromboplastin time(APTT), plasma prothrombin time(PT), plasma fibrinogen(FG), and plasma D-dimer(DD) were analyzed in the two groups. Multivariate logistic regression was used to analyze the related factors of venous thrombosis in lower limbs. ResultsAccording to the inclusion and exclusion criteria, a total of 69 patients were included in the study, including 14 patients in the thrombus group and 55 patients in the non thrombus group. There was no statistically significant difference in age (t=-1.439), gender (P=0.496), interval time between operation and injury (P=0.698), BMI (Z=-1.806), coagulation index (APTT: Z=-1.728, PT: t=-1.594, FG: Z=-1.081, DD: Z=-1.806) between the two groups (all P>0.05). There was no significant difference in anesthesia method (P=0.278), intraoperative blood loss (Z=-0.481), APTT(Z=-1.179) and PT (Z=-1.129) change two days after operation either. The changes of FG (Z=- 5.663) and DD (Z=- 5.745) in the thrombus group were significantly higher than those in the non thrombus group, and also the operation time (Z=- 4.377) was longer than that in the non thrombus group (P<0.05). Logistic regression analysis showed that prolonged operation time, increased FG level, increased DD level two days after operation were independent risk factors for DVT after THA of femoral neck fracture (OR=4.137, 10.105, 16.794, P < 0.05). ConclusionsThe increased time consuming of THA, high level of FG and DD after THA may be associated with DVT, which should be paid attention to. Targeted treatment can be taken to reduce the incidence of DVT and improve the prognosis of patients.