| 基于改良Caprini风险评估模型预测人工全膝关节置换术后深静脉血栓形成风险的确证性 |
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投稿时间：2021-08-27
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| 作者 | Author | 单位 | Address | E-Mail |
| 肖鹏 |
XIAO Peng |
四川省骨科医院下肢科, 四川 成都 610041 |
Department of Lower Limb, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China |
doctorxiao2012@163.com |
| 徐强 |
XU Qiang |
四川省骨科医院下肢科, 四川 成都 610041 |
Department of Lower Limb, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China |
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| 曹万军 |
CAO Wan-jun |
四川省骨科医院下肢科, 四川 成都 610041 |
Department of Lower Limb, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China |
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| 陈星宇 |
CHEN Xing-yu |
四川省骨科医院下肢科, 四川 成都 610041 |
Department of Lower Limb, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China |
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| 朱绍灵 |
ZHU Shao-ling |
四川省骨科医院下肢科, 四川 成都 610041 |
Department of Lower Limb, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China |
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| 期刊信息：《中国骨伤》2022年，第35卷，第3期，第253-257页 |
| DOI：10.12200/j.issn.1003-0034.2022.03.011 |
| 基金项目: |
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中文摘要:
目的: 探讨改良Caprini风险评估模型（modified Caprini risk assessment model，Caprini MRAM）预测人工全膝关节置换术（total knee arthroplasty，TKA）患者术后深静脉血栓形成（deep venous thrombosis，DVT）风险的有效性。
方法: 采用病例-对照研究设计（case-control study），回顾性连续收集2016年1月至2020年11月四川省骨科医院下肢科行TKA术后被确诊为DVT的43例患者为病例组，并按照1:4的比例纳入同时期入院行TKA未发生DVT的172例患者为对照组，采用Caprini MRAM对所有患者进行评分并进行危险度分级，比较2组患者的临床资料、评分及危险度分级构成等的差异，采用多因素Logistic回归模型分析Caprini MRAM危险度分级以及评估量表中的危险因素与TKA术后患者DVT发病风险之间的关系。
结果: DVT组的Caprini平均分高于对照组[（8.11±2.91） vs （4.07±2.12），P<0.001]；DVT组以中高危为主（66.67%），对照组以低危为主（77.33%），两组危险度分级构成之间差异有统计学意义（P<0.001）。体质量指数（body mass index，BMI） ≥ 30 kg/m2，下肢水肿（<1个月），严重肺部疾病（<1个月），急性心肌梗死（<1个月），卧床（>72 h），浅静脉、深静脉、肺栓塞病史，血栓家族史等7个Caprini风险评估量表中的危险因素是TKA术后患者发生DVT的主要危险因素（均P<0.05）。术前D-二聚体升高（OR=4.380），BMI ≥ 30 kg/m2（OR=2.518），下肢水肿（<1个月） （OR=7.652），急性心肌梗死（<1个月）（OR=1.994），卧床（>72 h）（OR=3.897），浅静脉、深静脉、肺栓塞病史（OR=13.517）和血栓家族史（OR=6.551）是TKA术后患者合并DVT的独立危险因素（均P<0.05）。Caprini MRAM分级为高危和中危TKA患者术后发生DVT的风险分别是低危患者的13.457倍和2.739倍。
结论: Caprini MRAM可用于预测TKA术后患者发生DVT的风险，尤其是针对风险等级被评估为高危患者。 |
| 【关键词】关节成形术,置换,膝 改良Caprini风险评估模型 深静脉血栓形成 危险因素 回归分析 |
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| Risk prediction for deep venous thrombosis after total knee arthroplasty based on modified Caprini risk assessment model:a confirmatory study |
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ABSTRACT
Objective: To investigate the effectiveness of modified Caprini risk assessment model(Caprini MRAM) in predicting the risk of deep venous thrombosis (DVT) after total knee arthroplasty (TKA).
Methods: A case-control study was used to collect 43 patients with DVT after TKA in lower limb department of Sichuan Orthopedic Hospital from January 2016 to November 2020 in the positive group,and 172 patients without DVT after TKA in the same period according to the 1:4 ratio between positive and control group were selected in the control group. Caprini MRAM was used to score and grade the risk of DVT. The clinical data,score and risk classification of the two groups were compared. The relationship between the risk of DVT in the patients after TKA and the risk factors in the risk ckassification and assessment of Caprini MRAM was analyzed by multivariate logistic regression model.
Results: The average score of caprini in DVT group was significantly higher than that in control group[(8.11±2.91) vs(4.07±2.12),P<0.001];DVT group was mainly at medium and high risk group(66.67%),while the control group was mainly at low risk (77.33%). There was a significant difference between the two groups in risk classification composition (P<0.001). BMI ≥ 30 kg/m2,lower extremity edema (<1 month),severe pulmonary disease (<1 month),acute myocardial infarction (<1 month),bed rest (> 2 h),history of superficial or deep vein or pulmonary embolism and family history of thrombosis were the main risk factors for DVT in patients after TKA(all P<0.05). Preoperative D-dimer elevation (OR=4.380),BMI ≥ 30 kg/m2(OR=2.518),lower extremity edema(<1 month)(OR=7.652),acute myocardial infarction (<1 month) (OR=1.994),bed rest (> 72 h)(OR=3.897),history of superficial or deep vein or pulmonary embolism (OR=13.517) and family history of blood embolism (OR=6.551) were independent risk factors for DVT in patients after TKA (all P<0.05). The risk of DVT was 13.457 and 2.739 times higher in high and moderate risk TKA patients with Caprini MRAM classification,respectively.
Conclusion: Caprini MRAM can be used to predict the risk of DVT in patients after TKA,especially for patients with high risk. |
| KEY WORDS Arthroplasty,replacement,knee Modified Caprini risk assessment model Deep vein thrombosis Risk factors Regression analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 肖鹏,徐强,曹万军,陈星宇,朱绍灵.基于改良Caprini风险评估模型预测人工全膝关节置换术后深静脉血栓形成风险的确证性[J].中国骨伤,2022,35(3):253~257 |
| 英文格式: | XIAO Peng,XU Qiang,CAO Wan-jun,CHEN Xing-yu,ZHU Shao-ling.Risk prediction for deep venous thrombosis after total knee arthroplasty based on modified Caprini risk assessment model:a confirmatory study[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(3):253~257 |
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