切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 601 -606. doi: 10.3877/cma.j.issn.1674-134X.2023.05.001

临床论著

上下肢关节镜手术后患者下肢深静脉血栓发生的对比研究
肖志满†(), 龚煜, 谢景凌, 刘斌伟   
  1. 362200　晋江市医院(上海市第六人民医院福建医院)骨科
  • 收稿日期:2023-04-20 出版日期:2023-10-01
  • 通信作者: 肖志满

Comparative study on occurrence of lower limb deep vein thrombosis after upper and lower limbs arthroscopic surgeries

Zhiman Xiao†(), Yu Gong, Jingling Xie, Binwei Liu   

  1. Department of Orthopaedics of Jinjiang Hospital (Fujian Hospital of Shanghai Sixth People's Hospital), Jinjiang 362200, China
  • Received:2023-04-20 Published:2023-10-01
  • Corresponding author: Zhiman Xiao
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

肖志满, 龚煜, 谢景凌, 刘斌伟. 上下肢关节镜手术后患者下肢深静脉血栓发生的对比研究[J]. 中华关节外科杂志(电子版), 2023, 17(05): 601-606.

Zhiman Xiao, Yu Gong, Jingling Xie, Binwei Liu. Comparative study on occurrence of lower limb deep vein thrombosis after upper and lower limbs arthroscopic surgeries[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(05): 601-606.

目的

对比研究上、下肢关节镜术后患者深静脉血栓(DVT)的发生情况，同时寻找引起上、下关节镜术后患者发生下肢DVT的危险因素，为关节镜术后DVT的评估及预防提供可靠的临床参考依据。

方法

回顾性收集晋江市医院2021年10月至2022年10月接受关节镜手术患者的一般资料及相关实验室指标，包括年龄、身体质量指数(BMI)、术后Caprini评分和术后D-二聚体等。排除术前彩超显示深静脉血栓的患者。根据不同的暴露因素，分为DVT组和无DVT组。暴露因素为计量资料的采用独立样本t检验、暴露因素为计数资料采用卡方检验，找出两组间差异具有统计学意义的可能危险因素进行修正Poisson回归分析。

结果

共有232例患者纳入本研究，其中有25例(10.8%)术后并发下肢DVT，均为远端DVT，其中小腿肌间静脉24例，胫后静脉合并胫前静脉1例，无一例术后发生肺栓塞(PE)；上、下肢关节镜术后DVT的发生率差异无统计学意义(P>0.05)。与无DVT组相比，年龄(t＝－2.140)、BMI(t＝－2.592)、术后Caprini评分(t＝－6.410)、手术时长(χ2＝12.262)、止血带使用时长(χ2＝6.812)、和术后D-二聚体(χ2＝7.719)的差异均具有统计学意义(均为P<0.05)。修正Poisson回归分析显示：BMI增加[相关危险度(RR)＝1.235，95%置信区间(CI)(1.084，1.408)，P<0.01]、术后Caprini评分增加[RR＝1.080，95%CI(1.062，1.312)，P<0.01]和术后D-二聚体升高[RR＝3.657，95%CI(1.465，9.130)，P<0.01]，是术后DVT的危险因素。

结论

上肢关节镜术后DVT的发生率不低于下肢关节镜术后DVT的发生，应引起临床医生的重视；BMI增加、术后Caprini评分增加和术后D-二聚体升高都是DVT发生的重要危险因素。

关键词: 关节镜检查, 静脉血栓形成, 危险因素
Objective

To compare the occurrence of DVT and identify the risk factors in patients after arthroscopic surgery for upper and lower limbs, providing reliable clinical reference for the evaluation and prevention of DVT after arthroscopic surgery.

Methods

Retrospective analysis was conducted to collect general information and relevant laboratory indicators of patients undergoing arthroscopic surgery in Jinjiang Hospital from October, 2021 to October, 2022. The patients with DVT displayed by color ultrasound before operation were excluded. According to different exposure factors, they were divided into DVT group and non-DVT group. To explore the risk factors that cause DVT after arthroscopic surgeries in upper and lower limbs, independent sample t test was used for measurement data of exposure factors, and chi square test was applied for counting data to identify potential risk factors. Modified Poisson regression analysis was performed on potential risk factors with statistically significant differences between the two groups.

Results

A total of 232 patients were enrolled. Among them, 25 (10.8%) had postoperative DVT in lower limb, and all were distal DVT. Among these 25 patiens, 24 cases were intermuscular veins in the calf, one case was posterior tibial vein combined with anterior tibial vein, and no postoperative pulmonary embolism (PE) occurred. There was no statistically significant difference in the incidence of DVT between upper and lower limb arthroscopy surgerie. Compared with the non-DVT group, there were statistically significant differences in age(t=-2.140), BMI(t=-2.592), postoperative Caprini score(t=-6.410), the duration of operation(χ2=12.262), the duration of using tourniquet(χ2=6.812), and postoperative D-dimer(χ2=7.719)(all P<0.05 ). Modified Poisson regression analysis showed that increased BMI [relative risk(RR)=1.235, 95%confidence interval(CI) (1.084, 1.408), P<0.01), postoperative Caprini score (RR=1.080, 95%CI(1.062, 1.312), P<0.01) and postoperative D-dimer increase (RR=3.657, 95%CI(1.465, 9.130), P<0.01) were risk factors for postoperative DVT.

Conclusions

The incidence of DVT after arthroscopy in upper limb is not lower than that after arthroscopy in lower limb, which should be taken seriously by clinical doctors. An increase in BMI, postoperative Caprini score, and postoperative D-dimer elevation are important risk factors for the occurrence of DVT.

Key words: Arthroscopy, Deep venous thrombosis, Risk factors
表1 上、下肢关节镜术后DVT相关因素(计量资料)(±s)
Table 1 Relevant factors of DVT after arthroscopic surgeries in upper and lower limbs (measurement data)
组别Groups 例数Number of cases 年龄(岁)Age(years) BMI(kg/m2) 术后Caprini评分Postoperative Caprini score 甘油三酯Triglyceride(mmol/L) HDL(mmol/L) LDL(mmol/L)
无DVT组Non-DVT group 207 44.4±15.7 24.3±3.2 5.17±2.2 1.79±1.3 1.5±0.4 2.8±0.8
DVT组DVT group 25 51.4±13.1 26.0±2.7 8.3±2.7 2.1±2.1 1.4±0.4 2.7±0.9
t值   －2.140 －2.592 －6.410 －1.076 1.001 0.536
P值   0.033 0.010 <0.001 >0.05 >0.05 >0.05
组别Groups 例数Number of cases ALP(U/L) WBC(×109/L) RBC(×1012/L) HB(g/L) HCT(%) 钠离子浓度Sodium ion concentration(mmol/L)
无DVT组Non-DVT group 207 81.0±23.5 6.8±2.1 4.6±0.6 137.4±16.2 41.2±4.4 138.7±2.5
DVT组DVT group 25 77.8±25.5 7.6±2.6 4.4±0.6 131.3±14.4 39.5±4.1 138.4±2.1
t值   0.642 －1.787 1.443 1.798 1.869 0.574
P值   >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表2 上、下肢关节镜术后DVT的相关因素(计数资料)[例(%)]
Table 2 Relevant factors of DVT after arthroscopic surgeries in upper and lower limbs(counting data)
组别Groups 例数Number of cases 性别Gender 手术部位Surgical site 术后D-二聚体Postoperative D-dimer
男Male 女Female 上肢Upper limbs 下肢Lower limbs ≤1 mg/L >1 mg/L
DVT组DVT group 25 13(9.8) 12(12.0) 7(15.2) 18(9.7) 6(3.9) 19(24.7)
无DVT组Non-DVT group 207 119(90.2) 88(88.0) 39(84.8) 168(90.3) 149(96.1) 58(75.3)
χ2值   0.274 0.672 7.719
P值   >0.05 >0.05 <0.001
组别Groups 例数Number of cases 手术时长Surgical duration 麻醉方式Anesthesia methods 术中止血带使用时长Duration of tourniquet in operation
≤120 min >120 min 腰麻Spinal anesthesia 非腰麻Non-Spinal anesthesia <120 min ≥120 min
无DVT组Non-DVT group 207 8(5.4) 17(20.2) 1(6.7) 24(11.1) 13(7.6) 12(19.7)
DVT组DVT group 25 140(94.6) 67(79.8) 14(93.3) 193(89.9) 158(93.4) 49(80.3)
χ2值   12.262 0.010 6.812
P值   <0.001 >0.05 0.009
表3 修正Poisson回归分析上、下肢关节镜术后DVT发生的危险因素
Table 3 Risk factors of DVT after upper and lower arthroscopy by modified Poisson regression analysis
参数Parameter B值 P值 RR 95% CI
手术时长Surgical duration        
>120 min 0.434 0.387 1.543 0.577~4.123
≤120 min － － 1 －
术中止血带使用时长Duration of Tourniquet in operation        
≥120 min 0.299 0.372 1.349 0.699~2.601
<120 min － － 1 －
术后D-二聚体Postoperative D-dimer        
>1 mg/L 1.297 0.005 3.657 1.465~9.130
≤1 mg/L － － 1 －
年龄(岁)Age (years) 0.023 0.177 1.024 0.989~1.059
BMI(kg/m2) 0.211 0.002 1.235 1.084~1.408
术后Caprini评分Postoperative Caprini score 0.166 0.002 1.180 1.062~1.312
[1]
Schulman S, Ageno W, Konstantinides SV. Venous thromboembolism: past, present and future[J]. Thromb Haemost, 2017, 117(7): 1219－1229.
[2]
Ruskin KJ. Deep vein thrombosis and venous thromboembolism in trauma[J]. Curr Opin Anaesthesiol, 2018, 31(2): 215－218.
[3]
Cai X, Wang Z, Wang XL, et al. Correlation between the fracture line plane and perioperative deep vein thrombosis in patients with tibial fracture[J/OL]. Clin Appl Thromb Hemost, 2021, 27: 10760296211067258. DOI: 10.1177/10760296211067258.
[4]
中华医学会外科学分会血管外科学组．深静脉血栓形成的诊断和治疗指南(第三版)[J]. 中华普通外科杂志，2017, 32(9): 807－812.
[5]
Brill JB, Badiee J, Zander AL, et al. The rate of deep vein thrombosis doubles in trauma patients with hypercoagulable thromboelastography[J]. J Trauma Acute Care Surg, 2017, 83(3): 413－419.
[6]
Trivedi NN, Abola MV, Kim CY, et al. The incremental cost of inpatient venous thromboembolism after hip fracture surgery[J]. J Orthop Trauma, 2020, 34(4): 169－173.
[7]
Di Nisio M, van Es N, Büller HR. Deep vein thrombosis and pulmonary embolism[J]. Lancet, 2016, 388(10063): 3060－3073.
[8]
柯贤鹏. 膝关节镜术后下肢深静脉血栓发生相关因素分析[D]．唐山：华北理工大学，2016.
[9]
Pandey A, Patni N, Singh M, et al. Assessment of risk and prophylaxis for deep vein thrombosis and pulmonary embolism in medically ill patients during their early days of hospital stay at a tertiary care center in a developing country[J]. Vasc Health Risk Manag, 2009, 5: 643－648.
[10]
Fang CH, Liu H, Zhang JH, et al. An unusual case of symptomatic deep vein thrombosis and pulmonary embolism after arthroscopic meniscus surgery[J/OL]. BMC Musculoskelet Disord, 2018, 19(1): 19. DOI: 10.1186/s12891-017-1919-0.
[11]
马宁，孙福荣，高想，等. 关节镜下后交叉韧带重建术后深静脉血栓的发生率及危险因素分析[J]. 中国骨与关节损伤杂志，2019, 34(10): 1074－1076.
[12]
Bokshan SL, DeFroda SF, Panarello NM, et al. Risk factors for deep vein thrombosis or pulmonary embolus following anterior cruciate ligament reconstruction[J/OL]. Orthop J Sports Med, 2018, 6(6): 2325967118781328. DOI: 10.1177/2325967118781328.
[13]
Krych AJ, Sousa PL, Morgan JA, et al. Incidence and risk factor analysis of symptomatic venous thromboembolism after knee arthroscopy[J]. Arthroscopy, 2015, 31(11): 2112－2118.
[14]
Truntzer JN, Hoppe DJ, Shapiro LM, et al. Complication rates for hip arthroscopy are underestimated: a population-based study[J]. Arthroscopy, 2017, 33(6): 1194－1201.
[15]
Takahashi H, Yamamoto N, Nagamoto H, et al. Venous thromboembolism after elective shoulder surgery: a prospective cohort study of 175 patients[J]. J Shoulder Elbow Surg, 2014, 23(5): 605－612.
[16]
张灵丽，陈东阳，姚尧，等. >40岁关节镜术后下肢深静脉血栓的危险因素及干预[J]. 南京医科大学学报(自然科学版), 2019, 39(12): 1830－1833.
[17]
Fu YH, Liu P, Xu X, et al. Deep vein thrombosis in the lower extremities after femoral neck fracture: a retrospective observational study[J/OL]. J Orthop Surg, 2020, 28(1)：2309499019901172. DOI: 10.1177/2309499019901172.
[18]
Matthews JM, Wessel SS, Pate RC, et al. Pulmonary embolism after arthroscopic bankart and rotator cuff repair[J]. Kans J Med, 2017, 10(2): 43－46.
[19]
姚尧，王业贤，徐瑞娟，等. 肩关节镜下肩袖修补术后深静脉血栓形成1例[J]. 中国运动医学杂志，2018, 37(7): 608－610.
[20]
卢钰，张俊，解京明，等. 肩关节镜术后肺栓塞：一例报告及文献复习[J/OL]. 中华肩肘外科电子杂志，2018, 6(1): 64－67.
[21]
Zhu Y, Chen W, Li J, et al. Incidence and locations of preoperative deep venous thrombosis (DVT) of lower extremity following tibial plateau fractures: a prospective cohort study[J/OL]. J Orthop Surg Res, 2021, 16(1): 113. DOI: 10.1186/s13018-021-02259-y.
[22]
徐留海，曾勇，黄卫，等. 基于Caprini血栓风险模型评估膝关节镜手术患者深静脉血栓形成的风险性[J]. 中国组织工程研究，2016, 20(17): 2474－2480.
[23]
蔺超，刘涛，任强，等. 膝关节镜手术术后静脉血栓形成危险因素分析[J]. 中国内镜杂志，2017, 23(5): 64－68.
[24]
姬振伟，徐奎，吴鹏，等. 膝关节镜术后VTE的发生率及其抗凝策略分析[J]. 实用骨科杂志，2018, 24(8): 696－700.
[1] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[2] 马艳波, 华扬, 刘桂梅, 孟秀峰, 崔立平. 中青年人颈动脉粥样硬化病变的相关危险因素分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 822-826.
[3] 黄应雄, 叶子, 蒋鹏, 詹红, 姚陈, 崔冀. 急性肠系膜静脉血栓形成致透壁性肠坏死的临床危险因素分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 413-421.
[4] 张再博, 王冰雨, 焦志凯, 檀碧波. 胃癌术后下肢深静脉血栓危险因素的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 475-480.
[5] 陈旭渊, 罗仕云, 李文忠, 李毅. 腺源性肛瘘经手术治疗后创面愈合困难的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 82-85.
[6] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[7] 吴方园, 孙霞, 林昌锋, 张震生. HBV相关肝硬化合并急性上消化道出血的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 45-47.
[8] 晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[9] 莫闲, 杨闯. 肝硬化患者并发门静脉血栓危险因素的Meta分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 678-683.
[10] 毛永欢, 仝瀚文, 缪骥, 王行舟, 沈晓菲, 喻春钊. 造口旁疝危险因素预测模型构建[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 682-687.
[11] 侯超, 潘美辰, 吴文明, 黄兴广, 李翔, 程凌雪, 朱玉轩, 李文波. 早期食管癌及上皮内瘤变内镜黏膜下剥离术后食管狭窄的危险因素[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 383-387.
[12] 张雯, 宋牡丹, 邓雪婷, 张云. 强化营养支持辅助奥曲肽治疗肝硬化合并食管胃底静脉曲张破裂出血的疗效及再出血危险因素[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 456-460.
[13] 陆猛桂, 黄斌, 李秋林, 何媛梅. 蜂蛰伤患者发生多器官功能障碍综合征的危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1010-1015.
[14] 李达, 张大涯, 陈润祥, 张晓冬, 黄士美, 陈晨, 曾凡, 陈世锔, 白飞虎. 海南省东方市幽门螺杆菌感染现状的调查与相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 858-864.
[15] 李琪, 黄钟莹, 袁平, 关振鹏. 基于某三级医院的ICU多重耐药菌医院感染影响因素的分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 777-782.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号