类风湿关节炎患者术后深静脉血栓形成危险因素分析

doi:10.3877/cma.j.issn.1674-134X.2021.01.008

目的

分析类风湿关节炎患者行全膝关节置换术后深静脉血栓发生情况及分析危险因素。

方法

回顾性分析2010年3月至2018年12月南京鼓楼医院运动医学与成人重建外科116例接受全膝关节置换术的类风湿关节炎患者血栓发生情况，其中男性12例，女性104例，纳入标准为诊断明确，行标准全膝关节置换术，有完整术前术后血栓筛查，排除诊断不明，行部分关节置换，术前存在血栓，合并其他手术指征及术后不能完成血栓筛查的患者。记录年龄，性别，身体质量指数，是否合并高血压、糖尿病、高血脂，术后卧床时间，疼痛视觉模拟评分，按照深静脉血栓发生情况分为血栓组和无血栓组，比较两组血栓发生率及各项指标的差异，分类变量比较采用卡方检验，计量资料比较采用t检验，并采用logistic回归分析验证各危险因素与血栓形成的相关性。

结果

共17例发生深静脉血栓，发生率14.7%(17/116)，所有病例血栓均稳定，无一例发生肺栓塞。血栓组平均年龄(62.8±8.8)岁，高于非血栓组的(56.4±11.1)岁(t＝2.272，P＝0.025)，且血栓组年龄65岁以上人群比例47.1%，高于非血栓组的21.2%(χ²＝3.88，P＝0.049)，多因素回归分析发现年龄≥65岁是术后发生深静脉血栓的独立危险因素(OR＝1.265，P＝0.032)。

结论

类风湿关节炎患者行全膝关节置换术后深静脉血栓发生率不低，年龄≥65岁是类风湿关节炎患者全关节置换术后发生深静脉血栓的独立危险因素，建议对老年患者进行更为积极的血栓预防。

关键词: 关节炎, 类风湿, 关节成形术, 置换, 膝, 静脉血栓形成, 危险因素

Objective

To analyze the incidence of deep venous thrombosis after total knee arthroplasty in patients with rheumatoid arthritis and to analyze the risk factors.

Methods

One hundred and sixteen cases of rheumatoid arthritis patients undergoing total knee arthroplasty in the Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital from March 2010 to December 2018 were retrospectively analyzed, including 12 males and 104 females. Inclusion criteria were definite diagnosis, standard total knee arthroplasty, and available for preoperative and postoperative examination of thrombosis. Those without definite diagnosis, treated with unicompartmental knee arthroplasty, with preoperative thrombosis or unable to accept relating examinations were excluded. Age, gender, body mass index, hypertension, diabetes, triglycerides, postoperative bed rest time and pain visual analogue scale score were recorded. The patients were divided into thrombosis group and non-thrombosis group according to the incidence of deep vein thrombosis, and the difference of figures were compared. Chi-square test was used to examine categorical variables, and paired t test was adopted for metering data. Logistic regression analysis was used to verify the correlation of various risk factors and thrombosis.

Results

Seventeen cases developed deep vein thrombosis, and the incidence rate was 14.7% (17/116). All the thrombosis was stable and no pulmonary embolism occurred. Thrombosis group had higher average age than the non-thrombosis group[(62.8±8.8) vs (56.4±11.1)years, t =2.272, P=0.025], and the proportion of people over 65 years old in thrombosis group was 47.1%, higher than 21.2% of the non-thrombosis group (χ²=3.88, P=0.049). Multivariate regression analysis revealed that age ≥65 years was an independent risk factor of postoperative deep vein thrombosis (OR=1.265, P =0.032).

Conclusions

The incidence of deep vein thrombosis after total knee arthroplasty in patients with rheumatoid arthritis is not low. Age ≥ 65 years is an independent risk factor for deep vein thrombosis after total joint replacement in patients with rheumatoid arthritis and it is suggested to conduct more aggressive thromboprophylaxis to those patients.

Key words: Arthritis, rheumatoid, Arthroplasty, replacement, knee, Venous thrombosis, Risk factors

表1 类风湿关节炎患者全膝关节置换术后深静脉血栓发生危险因素的单因素分析

	无血栓组	血栓组	统计值	P值
例数	99	17
性别[男，例(%)]	11(11.1)	1(5.9)	χ²＝0.050	>0.05
年龄≥65岁[例(%)]	21(21.2)	8(47.1)	χ²＝3.883	0.049
合并高血压[例(%)]	30(30.3)	4(23.5)	χ²＝0.078	>0.05
合并糖尿病[例(%)]	11(11.1)	4(23.5)	χ²＝1.037	>0.05
年龄[岁，(±s)]	56.4±11.1	62.8±8.8	t ＝2.272	0.025
卧床时间[d，(±s)]	3.1±1.1	3.0±1.2	t＝0.203	>0.05
甘油三酯[mmol/L，(±s)]	1.2±0.6	1.3±0.6	t＝2.063	>0.05
VAS评分(±s)	2.9±1.5	2.2±1.6	t＝1.553	>0.05
BMI[kg/m²，(±s)]	23.1±4.7	23.8±3.4	t＝0.594	>0.05

表1 类风湿关节炎患者全膝关节置换术后深静脉血栓发生危险因素的单因素分析

	无血栓组	血栓组	统计值	P值
例数	99	17
性别[男，例(%)]	11(11.1)	1(5.9)	χ²＝0.050	>0.05
年龄≥65岁[例(%)]	21(21.2)	8(47.1)	χ²＝3.883	0.049
合并高血压[例(%)]	30(30.3)	4(23.5)	χ²＝0.078	>0.05
合并糖尿病[例(%)]	11(11.1)	4(23.5)	χ²＝1.037	>0.05
年龄[岁，(±s)]	56.4±11.1	62.8±8.8	t ＝2.272	0.025
卧床时间[d，(±s)]	3.1±1.1	3.0±1.2	t＝0.203	>0.05
甘油三酯[mmol/L，(±s)]	1.2±0.6	1.3±0.6	t＝2.063	>0.05
VAS评分(±s)	2.9±1.5	2.2±1.6	t＝1.553	>0.05
BMI[kg/m²，(±s)]	23.1±4.7	23.8±3.4	t＝0.594	>0.05

表2 类风湿关节炎患者全膝关节置换术后深静脉血栓发生危险因素的logistic回归分析

项目	OR值	95%置信区间	P值
性别	2.608	(0.248，27.368)	0.424
老年	1.265	(1.079，1.890)	0.032
高血压	2.949	(0.663，13.116)	0.156
糖尿病	0.364	(0.079，0.890)	0.194
卧床时间	1.352	(0.463，3.953)	0.156
VAS	0.716	(0.475，1.081)	0.828
甘油三酯	1.352	(0.463，3.953)	0.581
BMI	1.052	(0.926，1.194)	0.437

表2 类风湿关节炎患者全膝关节置换术后深静脉血栓发生危险因素的logistic回归分析

项目	OR值	95%置信区间	P值
性别	2.608	(0.248，27.368)	0.424
老年	1.265	(1.079，1.890)	0.032
高血压	2.949	(0.663，13.116)	0.156
糖尿病	0.364	(0.079，0.890)	0.194
卧床时间	1.352	(0.463，3.953)	0.156
VAS	0.716	(0.475，1.081)	0.828
甘油三酯	1.352	(0.463，3.953)	0.581
BMI	1.052	(0.926，1.194)	0.437

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Risk factors for deep vein thrombosis after arthroplasty in patients with rheumatoid arthritis

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Risk factors for deep vein thrombosis after arthroplasty in patients with rheumatoid arthritis