| 常规止血带下膝关节镜手术后早期深静脉血栓的发生率及危险因素分析 |
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投稿时间：2018-06-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 陈成帷 |
CHEN Cheng-wei |
温州医科大学附属第一医院骨科, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
crystalmon@126.com |
| 潘哲尔 |
PAN Zhe-er |
温州医科大学附属第一医院骨科, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 周也立 |
ZHOU Ye-li |
温州医科大学附属第一医院骨科, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 刘彩龙 |
LIU Cai-long |
温州医科大学附属第一医院骨科, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 吴李闯 |
WU Li-chuang |
温州医科大学附属第一医院骨科, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 陈雷 |
CHEN Lei |
温州医科大学附属第一医院骨科, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2018年，第31卷，第9期，第829-834页 |
| DOI：10.3969/j.issn.1003-0034.2018.09.010 |
| 基金项目:温州市科技计划项目（编号：Y20160387） |
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中文摘要:
目的：研究常规止血带下单侧膝关节镜术后早期下肢深静脉血栓（DVT）的发生率并探讨其发生的相关危险因素。
方法：回顾性分析2013年1月至2017年1月住院接受单侧膝关节镜手术符合纳入排除标准的1 561例患者，其中男651例，女910例，年龄62~81（65.7±8.7）岁，根据术后超声将患者分为DVT组和非DVT组，统计分析术后早期的DVT发生率，通过单因素及多因素分析筛选出能够预测DVT发生的危险因素。所有出现DVT的患者常规抗凝治疗6个月，并于初次诊断后1、3、6个月门诊随访，行超声多普勒检查再次评估。
结果：1 561例患者中226例（14.5%）出现DVT。其中发生在近端的DVT患者32例（2.0%），单独发生在肢体远端的DVT患者194例（12.4%）。术后DVT的危险因素包括高龄（≥ 73岁），女性，腓肠肌静脉扩张，高血压，止血带使用时间（≥ 74 min）。腓肠肌静脉扩张和止血带使用时间是预测DVT发生率的较强独立危险因素，OR值分别为2.337（95% CI，1.644-3.611）和2.112（95% CI，1.452-3.301）。6个月门诊随访发现12例远端DVT （6.6%）和11例近端DVT （36.7%）仍然表现为血栓，但体积减小并出现不同程度的溶解。
结论：常规止血带下接受膝关节镜手术后早期DVT的发生率为14.5%，在所有因素中，腓肠肌静脉扩张和止血带使用时间是术后DVT发生的较强预测因素。无论是近端DVT还是远端DVT经过及时正规治疗后效果都较为满意。 |
| 【关键词】关节镜 止血带 深静脉血栓 危险因素 |
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| Incidence and risk factors of early deep venous thrombosis after knee arthroscopy operation under conventional tourniquet |
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ABSTRACT
Objective: To find out the incidence of early DVT in patients after knee arthroscopic surgery with routine use of tourniquet and discuss the associate risk factors.
Methods: Total 1 561 cases undertaken primary knee arthroscopic surgery was reviewed retrospectively from January 2013 to January 2017,including 651 males and 910 females with a mean age of (65.7±8.7) years old ranging from 62 to 81 years old. The cases were divided into DVT group and non-DVT group according to ultrasonic Doppler after surgery. The DVT occurrence rate was calculated and the basic information was analyzed to filter out the risk factors through univariate analysis and multivariate analysis. The cases of DVT group received 6 months anticoagulation therapy and were undertaken a follow-up of 1,3,6 months by ultrasonic Doppler.
Results: Out of the 1 561 cases,226(14.5%) developed early DVTs following surgery,32(2.0%) cases had the proximal DVTs,and 194(12.4%) cases had the isolated distal DVTs. The risk factors include the age(≥ 73 years),female sex and gastrocnemius vein dilation (GVD),hypertension,longer tourniquet time(≥ 74 min). The GVD and the length of tourniquet time was considered to be the best predictor of the early DVTs after surgery,with an odds ratio of 2.337 (95% CI,1.644-3.611) and 2.112 (95%CI,1.452-3.301). Twelve isolated distal DVTs(6.6%) and 11 proximal DVTs(36.7%) still showed thrombus at 6-month follow-up,but exhibit decreased size and at various stage of resolution.
Conlusion: The incidence of early DVTs after knee arthroscopic surgery is 14.5%. Out of all risk factors,the GVD and the length of tourniquet time have the best power for prediction of DVTs after surgery. Both proximal and distal DVTs received accepted outcomes after formal therapy. |
| KEY WORDS Arthroscopes Tourniquets Deep venous thrombosis Risk factors |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈成帷,潘哲尔,周也立,刘彩龙,吴李闯,陈雷.常规止血带下膝关节镜手术后早期深静脉血栓的发生率及危险因素分析[J].中国骨伤,2018,31(9):829~834 |
| 英文格式: | CHEN Cheng-wei,PAN Zhe-er,ZHOU Ye-li,LIU Cai-long,WU Li-chuang,CHEN Lei.Incidence and risk factors of early deep venous thrombosis after knee arthroscopy operation under conventional tourniquet[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(9):829~834 |
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