| 王剑锋,黄小强,李辉,等.全膝关节置换术后下肢肌间静脉血栓的转归及影响因素.骨科,2021,12(2): 137-142. |
| 全膝关节置换术后下肢肌间静脉血栓的转归及影响因素 |
| Outcome of muscular vein thrombosis after total knee arthroplasty |
| 投稿时间：2020-04-30 |
| DOI：10.3969/j.issn.1674-8573.2021.02.008 |
| 中文关键词: 关节成形术，置换，膝 危险因素 肌间静脉血栓 |
| 英文关键词: Arthroplasty, replacement, knee Risk factors Muscular vein thrombosis |
| 基金项目:陕西省重点研发计划资助项目（2019SF-192） |
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| 中文摘要: |
| 目的 探讨全膝关节置换术（total knee arthroplasty，TKA）后下肢肌间静脉血栓的转归及影响因素。方法 回顾性分析2019年6月至10月行单侧TKA术后由下肢深静脉彩超确诊的新鲜肌间静脉血栓病人64例，男29例，女35例；年龄为（56.3±7.7）岁（46~82岁）。彩色超声多普勒观察肌间静脉血栓在术后2周、6周、3个月的溶解情况。分析年龄、性别、身体质量指数（body mass index，BMI）、术中止血带应用、麻醉方式、血栓最大直径、抗凝时间等因素对肌间静脉血栓转归的影响。结果 术后2周复查时13例（20.3%）血栓消散，37例（57.8%）部分溶解，12例（18.8%）无变化，2例（3.1%）近端延伸；术后6周时33例（51.6%）血栓消散，27例（42.2%）部分溶解，4例（6.3%）无变化；术后3个月时55例（85.9%）血栓消散，9例（14.1%）部分溶解。术后3个月内所有病人未发现肺栓塞、血栓栓塞后综合征及大出血等严重并发症。单因素和有序Logistic回归分析先后证实术中是否应用止血带、麻醉方式、血栓最大直径是否＞0.7 cm、是否延长抗凝时间是（术后2周、6周、3个月时）肌间静脉血栓转归的独立影响因素。结论 TKA术后肌间静脉血栓的转归趋向于自然消失；术中不用止血带、选择收肌管阻滞麻醉有利于TKA术后肌间血栓的消散；肌间静脉血栓最大直径＜0.7 cm时容易消散且不易向近端延伸。 |
| 英文摘要: |
| Objective To observe the outcome of muscular vein thrombosis after total knee arthroplasty and to analyze influencing factors. Methods From June 2019 to October 2019, a total of 64 fresh muscular vein thromboses diagnosed by ultrasound were collected during hospitalization. There were 29 males and 35 females with the average age of 56.3±7.7 years old (46-82 years old). Sonography was used to evaluate the resolution of muscular vein thromboses at the time point of 2 and 6 weeks and 3 months postoperatively and the results were compared among the three time points. Multivariable analysis was performed to evaluate the relationship between the resolution of DVT postoperatively and risk factors including age (＞65/≤65 years old), body mass index (＞25/≤25 kg/m2), gender (male/female), maximum diameter (＞0.7/≤0.7 cm), duration of anticoagulation therapy (extended anticoagulation therapy after discharge/anticoagulation therapy during hospitalization). Results At 2nd week postoperatively, 64 cases (34 at left and 30 at right) of muscular vein thromboses were found resolving with 13 cases (20.3%) thoroughly resolved and 37 cases (57.8%) partly resolved, only 2 cases (3.1%) progressed but not into the popliteal veins, and 12 cases (18.8%) had no change on the size. At 6th week postoperatively, 33 cases (51.6%) thoroughly resolved and 27 cases (42.2%) partly resolved, no thrombosis progressed, 4 cases (6.3%) had no change on the size. At the follow up of 3 months, 55 cases (85.9%) of thromboses completely resolved and 9 cases (14.1%) partly resolved, no case progressed into proximal veins, and no case had no change on the size. No severe complications of pulmonary embolism (PE), post-thromboembolic syndrome and major hemorrhage occurred in all patients within 3 months. The mode of anesthesia, use of a pneumatic tourniquet the maximum diameter of thrombus and prolonging anticoagulation time were independent factors influencing the outcome of muscular venous thrombosis. Conclusion The outcome of muscular venous thrombosis after TKA tends to disappear naturally, no tourniquet and adductor tube block anesthesia are beneficial to the dissipation of muscular thrombus after TKA, and the muscular thrombus is not easy to extend to the proximal and dissipate more easily when the maximum diameter of muscular thrombus is less than 0.7 cm. |
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