目的 了解人工全膝关节置换术(total knee arthroplasty, TKA)后症状性下肢深静脉血栓(deep vein thrombosis,DVT)患者的临床特点及高危因素。方法 回顾性研究2015-07至2020-06北京积水潭医院收治的8162例TKA患者临床资料,记录术后出现症状性DVT及继发的肺动脉血栓栓塞症(pulmonary thromboembolism,PTE)情况,分析患者年龄、身体质量指数、手术时间、高血压病史、糖尿病病史、术前D二聚体、术前三酰甘油、术前胆固醇及术前血尿酸与症状性DVT发生风险的相关性。结果 TKA术后有65例症状性DVT患者(0.80%),中位发生时间为术后第3天,远端DVT占比(73.85%)明显高于近端DVT(26.15%);继发症状性PTE有5例,仅1例为高危分层。术前血尿酸增高是症状性DVT的危险因素(OR=2.532;95% CI=1.207~5.310;P=0.014)。结论 TKA患者尽管给予常规预防,但仍无法避免术后症状性DVT的发生,对于术前血尿酸增高的患者在围术期预防中需给予更多关注。
Abstract
Objective To investigate the clinic features and risk factors for symptomatic deep vein thrombosis (DVT) patients after total knee arthroplasty (TKA). Methods A total of 8162 patients undergoing TKA were included in this study. Cases of symptomatic DVT and pulmonary thromboembolism (PTE) were recorded. The association of age, body mass index ( BMI), duration of surgery, a history of hypertension and diabetes, and preoperative serum levels of uric acid, cholesterol,triglyceride and D-dimer with symptomatic DVT was analyzed. Results Sixty-five patients(0.80%)presented with symptomatic DVT, which occurred within median 3 days postoperatively. These cases included 48 cases of distal DVT (73.85%) and 17 cases of proximal DVT(26.15%). There were 5 cases of pulmonary thromboembolism (PTE) after TKA, only one of whom was at high risk. The preoperative serum levels of uric acid in symptomatic DVT patients were significantly higher than those of other patients,indicating correlations (OR=2.532; 95% CI=1.207-5.310;P=0.014) between the preoperative serum levels of uric acid and symptomatic DVT. Conclusions Postoperative DVT can hardly be prevented despite conventional precautions. An increased preoperative serum level of uric acid is a risk factor for symptomatic DVT after TKA. Therefore, effective preventive measures are needed for these patients.
关键词
人工全膝关节置换术 /
下肢深静脉血栓 /
肺动脉血栓栓塞症
Key words
total knee arthroplasty /
deep vein thrombosis /
pulmonary thromboembolism
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参考文献
[1] Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030[J]. J Bone Joint Surg Am, 2007,89(4):780-785.
[2] Gharaibeh L, Albsoul-Younes A, Younes N. Evaluation of VTE prophylaxis in an educational hospital: comparison between the institutional guideline (Caprini 2006) and the ACCP guideline (Ninth Edition)[J]. Clin Appl Thromb Hemost, 2016,22(7):627-632.
[3] Baud J M, Matrand G, Georges J L, et al. Diagnostic value of clinical signs and clinical scoring for deep vein thrombosis after hip and knee arthroplasty [J]. J Mal Vasc, 2011,36(6):386-394.
[4] Stein P D, Beemath A, Olson R E. Obesity as a risk factor in venous thromboembolism[J]. Am J Med, 2005,118(9):978-980.
[5] Mantilla C B, Horlocker T T, Schroeder D R, et al. Risk factors for clinically relevant pulmonary embolism and deep venous thrombosis in patients undergoing primary hip or knee arthroplasty[J]. Anesthesiology, 2003,99(3):552-560, 5A.
[6] Pedersen A B, Sorensen H T, Mehnert F, et al. Risk factors for venous thromboembolism in patients undergoing total hip replacement and receiving routine thromboprophylaxis[J]. J Bone Joint Surg Am, 2010,92(12):2156-2164.
[7] Tsai A W, Cushman M, Rosamond W D, et al. Cardiovascular risk factors and venous thromboembolism incidence[J]. Arch Intern Med, 2002,162(10):1182-1189.
[8] Falck-Ytter Y, Francis C W, Johanson N A, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J]. Chest, 2012,141(2 Suppl):e278S-e325S.
[9] Warren J A, Sundaram K, Anis H K, et al. Have venous thromboembolism rates decreased in total hip and knee arthroplasty?[J]. J Arthroplasty, 2020,35(1):259-264.
[10] Yamaguchi T, Hasegawa M, Niimi R, et al. Incidence and time course of asymptomatic deep vein thrombosis with fondaparinux in patients undergoing total joint arthroplasty[J]. Thromb Res, 2010,126(4):e323-e326.
[11] 刘 旭, 姚 尧, 戎 朕, 等. 全膝关节置换术后下肢深静脉血栓发生的时间分布[J]. 中国矫形外科杂志, 2015, 23(11):991-995.
[12] Mori N, Kimura S, Onodera T, et al. Use of a pneumatic tourniquet in total knee arthroplasty increases the risk of distal deep vein thrombosis: a prospective, randomized study[J]. Knee, 2016, 23(5):887-889.
[13] Tsuji S, Kobayashi A, Tomita T, et al. Quantitative index for deciding whether to administer preventive anticoagulant therapy in osteoarthritis patients undergoing total knee arthroplasty[J]. J Orthop Sci, 2014,19(1):77-84.
[14] Kang D H, Park S K, Lee I K, et al. Uric acid-induced C-reactive protein expression: implication on cell proliferation and nitric oxide production of human vascular cells [J]. J Am Soc Nephrol, 2005,16(12): 3553-3562.
[15] Kubota Y, McAdams-DeMarco M, Folsom A R. Serum uric acid, gout, and venous thromboembolism: the atherosclerosis risk in communities study [J]. Thromb Res, 2016,144:144-148.
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