成人膝部骨肿瘤术后下肢深静脉血栓形成的临床危险因素分析

目的探讨影响成人膝部骨肿瘤术后下肢深静脉血栓（DVT）形成的危险因素及统计DVT的发生率。方法对2011年2月至2012年1月75例成人膝部骨肿瘤患者术后DVT发生情况进行分析。75例患者均未采取任何药物抗凝措施。男45例,女30例,平均年龄（35.55±16.75）岁。其中,良性肿瘤39例,恶性肿瘤36例;26例行肿瘤刮除植骨（或未植骨）内固定术,49例行肿瘤切除肿瘤型膝关节置换术（或膝关节假体翻修术）。术前及术后14d均采用彩色多普勒超声检查双下肢深静脉血流通畅情况及DVT的发生。对15项临床因素与膝部手术后DVT形成的相关性进行分析。结果术后发生DVT的患者为21例,总发生率为28%（21/75）。经Logistic多因素回归分析,DVT形成的危险因素有2个：年龄≥40岁、术前存在深静脉返流。两者使术后DVT形成的风险分别增加到13.337、13.538倍（P〈0.05）。结论年龄≥40岁和术前存在下肢深静脉返流是成人膝部骨肿瘤术后DVT发生的独立危险因素。肿瘤本身因素、是否采取过抗肿瘤治疗（化疗及放疗）、手术方式、是否使用骨水泥或异体骨等因素与DVT的形成无显著相关性。术前行下肢静脉彩色多普勒超声检查意义重大;应对年龄≥40岁或术前存在深静脉返流的患者积极采取药物抗凝措施以预防DVT的形成。

Clinical risk factors for deep vein thrombosis in adult after knee surgery for bone tumor

Objective To analyze the clinical risk factors for deep venous thrombosis(DVT) after knee operation in adult patients with primary bone tumor who did not receive prophylactic treatment for DVT and to find out the incidence of postoperative DVT. Methods We evaluated 75 patients who underwent knee surgery at our center from February 2011 to January 2012. There were 45 men and 30 women with a mean age of (35.55±16.75) years. Among all the 75 patients with primary bone tumor around the knee, 39 cases were benign and 36 cases were malignant. 26 patients underwent tumor curettage and bone graft (or not) with internal fixation, while the other 49 patients underwent tumor excision with endoprosthetic reconstruction. During the perioperative period no patient had been given any anticoagulant to prevent DVT. Color Doppler ultrasonography was used to detect DVT of bilateral lower extremities in all patients before surgery and at the 14th day after surgery. Fifteen clinical factors were closely examined to analyze their influences on DVT formation after surgery. Results There were 21 patients who developed DVT after surgery with an incidence of 28% (12/75). Logistic regression analysis showed that only two factors, age≥ 40 and deep venous insufficiency, were the independent risk factors for DVT, with odds ratio of 13.337 and 13.538 respectively. Other clinical factors mentioned had no statistically significant association with DVT. Conclusions Age ≥ 40 and deep venous insufficiency were risk factors for DVT after surgery, while other factors such as the characteristics of the tumor, anti-tumor therapy (chemotherapy or radiotherapy), and surgical procedure performed were not risk factors for DVT. We suggest that Color Doppler ultrasonography should be used before surgery to detect deep venous insufficiency, and prophylactic treatment for DVT should be adopted for patients with one or more risk factors.