人工全髋关节置换术后下肢深静脉血栓形成的多因素分析

目的:分析影响人工全髋关节置换术(THA)后下肢深静脉血栓形成(DVT)的危险因素。方法:对98例(112个关节)人工全髋置换术术后DVT发生情况进行分析。其中男55例,女43例;平均年龄59.12岁(41～81岁)。术前及术后7～10d均用彩色多普勒检查双下肢深静脉血流通畅情况及DVT的发生。对17项临床因素与人工关节置换术后DVT形成的相关性进行了分析。结果:术后发生DVT41例,DVT发生率为41.84%(41/98),其中无症状DVT患者占58.54%(24/41)。经Logistic多因素回归分析,与DVT相关的因素有5个,其中年龄、肥胖及肢体延长大于2cm使术后发生DVT的风险分别增加到1.952、3.349及7.376倍(P<0.05);硬膜外麻醉和踝泵练习使术后发生DVT的可能性减少到原来的0.132和0.265(P<0.01)。结论:年龄、肥胖及肢体延长大于2cm是人工关节置换术后发生DVT的危险因素,而硬膜外麻醉和踝泵练习是减少术后发生DVT的保护因素。关节置换术后无症状DVT的大量存在,提示术后最好常规行双下肢彩色多普勒检查,一旦有DVT发生,及时治疗,防止发生致命性肺栓塞。

Risk factors affected deep vein thrombosis after total hip arthroplasty

Objective:To analyze the clinical risk factors affected deep vein thrombosis (DVT) after total hip arthroplasty in Chinese north patients.Methods:Among 98 patients(112 hip joints)who underwent total hip arthroplasty (THA),55 patients were male and 43 patients were female,average age was 59.12 years(range,41 to 81 years).All patients received prophylactic treatment for DVT by low-molecular-weight heparin before and after operation.Color Doppler ultrasonography was used to detect DVT of bilateral lower extremities in all patients before operation and at 7 to 10 days after operation,meanwhile,seventeen clinical factors were examined in order to analyze their influences on DVT after surgery.Results:There were 41 patients who developed DVT after operation.The incidence of DVT in all patients was 41.84%(41/98).There were more asymptomatic DVT (58.54%,24/41) than the symptomatic.Logistic regression analysis demonstrated a definite association of age,obesity (representative by body mass index,BMI),low limb lengthening more than 2 cm,and anaesthesia method,ankle-pump with DVT.Among those 5 factors first 3 increased the risk of DVT with 1.952,3.349,7.376 times,the last two decreased the risk with 0.132 and 0.265 times respectively.Other clinical factors had no statistically significant association with DVT.Conclusion:Age,obesity,and low limbs lengthening more than 2 cm are risk factors for DVT after THA,epidural anaesthesia and ankle-pump training are protecting factors.Other clinical factors such as gender,OA,RA,monolateral or bilateral operation,cement usage,doctor are not risk factors for DVT.