初次全膝关节成形术后常规抗凝患者症状性静脉血栓症发生率的调查研究

背景：常规药物抗凝预防全膝关节成形术（total knee arthroplaty，TKA）后静脉血栓症（venous thromboembolism, VTE）已被众多指南推荐。尽管症状性VTE较无症状性VTE少见，但其临床意义更大。目前国人TKA术后常规预防抗凝后症状性VTE发生率的数据仍缺乏。 目的：调查遵照指南推荐预防措施后初次TKA后症状性VTE的发生率。 方法：2007年1月至2012年5月在北京协和医院接受初次TKA的1160例（1351膝）患者进入此前瞻性队列研究。男184例，女976例；对术后有症状患者应用Wells评分进行评判，符合条件者行下肢静脉超声检查。记录症状性静脉血栓栓塞症患者的一般资料、手术资料、放射学结果、处理与转归。 结果：共39例（56膝）患者出现症状性VTE，发生率3.36%。其中症状性深静脉血栓形成（deep vein thrombosis, DVT）37例（3.19%），症状性肺栓塞（pulmonary embolism, PE）2例（0.17%）；近端DVT 6例，远端DVT 31例；男2例，女37例；年龄54-81岁，平均68.4岁。原发病均为骨关节炎。症状性VTE发生中位时间为术后7 d（3-14 d）。预后均良好，无围手术期死亡病例。 结论：本研究报道初次TKA后常规抗凝后症状性VTE发生率较国外文献报告略高。对无症状患者无需常规筛查VTE。

Incidence of symptomatic venous thromboembolic events in patients undergoing primary total knee arthropalsty with routine anticoagulation

Background：Routine anticoagulation for prophylaxis of venous thromboembolic events （VTE） after total knee arthroplasty （TKA） has been supported by numerous guidelines. Although asymptomatic VTE is more common than symptomatic VTE, data demonstrate that symptomatic VTE is more clinically important, while the incidence of symptomatic VTE is lack after routine anticoagulation in China. Objective：To investigate the incidence of clinically symptomatic VTE in patients undergoing primary TKA with routine an-ticoagulation. Methods： The patients undergoing primary TKA in Peking Union Medical College Hospital from January 2007 to May 2012 were included in this prospective cohort study. Postoperative symptomatic patients were judged with Wells score sys-tem. Only the cases that met the criteria were refered for venous ultrasound. General information, operative information, ra-diological results, treatment and outcome were recorded. Results： Of the 1160 cases （1351 knees） in our cohort, 39 cases （56 knees, 2 males, 37 females） developed symptomatic VTE, and the incidence of VTE was 3.36%. There were 37 cases （3.19%） with deep vein thrombosis （DVT） and 2 cases （0.17%） with pulmonary embolism （PE）. In the patients with DVT, there were 6 cases with proximal DVT and 31 cases with distal DVT. The mean age of the patients with VTE were 68.4 years （range,54-81 years）. The primary disease were all osteo-arthritis. Symptomatic VTE occurred after a median time of 7 days （range, 3-14 days）. No patients died during perioperative period. Good prognosis was achieved. Conclusions：Incidence of symptomatic venous thromboembolic events in our cohort is slightly higher than abroad. Routine screening of asymptomatic patients is not necessary.