Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Arthroscopy. 2014 Jul;30(7):818-22. doi: 10.1016/j.arthro.2014.02.043. Epub 2014 Apr 24.
The purpose of this study was to assess the incidence of total venous thromboembolism (VTE) after knee arthroscopy with routinely applied venography.
We reviewed 537 consecutive patients undergoing arthroscopic knee surgery from March 2012 to July 2013. The surgical procedure was categorized as simple anterior cruciate ligament reconstruction (ACLR), posterior cruciate ligament reconstruction (PCLR), or reconstruction of both cruciate ligaments. All patients having arthroscopy in our institution were routinely examined with venography on the third postoperative day. Clinical signs of DVT were checked and recorded before venography.
Eighty (14.9%) of 537 patients were diagnosed with VTE by venography. Of the 80 detected cases of VTE, only 20 (3.7%) patients presented with clinical signs of DVT, indicating that there were 60 (11.2%) asymptomatic cases. No patient died or presented with a clinically suspected pulmonary embolism (PE). Sex, body mass index (BMI), operative time, and duration of tourniquet application were not significant risk factors for DVT. Patient age (P < .0001) is a strongly significant risk factor for deep venous thrombosis (DVT). Compared with patients who underwent simple arthroscopic procedures, complex procedures-the reconstruction of 1 (P < .005) or both knee cruciate ligaments (P < .0005)-led to a significantly higher postoperative incidence of DVT.
The total incidence of VTE diagnosed with venography after arthroscopic knee surgery was 14.9%, of which only 3.7% of cases were symptomatic, indicating 11.2% cases of silent VTE. Advanced age and complex arthroscopic surgery are strongly associated with VTE.
Level IV, prognostic case series.
本研究旨在评估常规静脉造影后膝关节镜检查术后总的静脉血栓栓塞症（VTE）发生率。
我们回顾了 2012 年 3 月至 2013 年 7 月期间接受关节镜膝关节手术的 537 例连续患者。手术过程分为单纯前交叉韧带重建（ACLR）、后交叉韧带重建（PCLR）或两条交叉韧带重建。我院所有接受关节镜检查的患者在术后第 3 天常规进行静脉造影检查。在静脉造影前检查并记录 DVT 的临床体征。
537 例患者中有 80 例（14.9%）通过静脉造影诊断为 VTE。在 80 例检测到的 VTE 病例中，只有 20 例（3.7%）患者出现 DVT 的临床症状，这表明有 60 例（11.2%）无症状病例。没有患者死亡或出现临床疑似肺栓塞（PE）。性别、体重指数（BMI）、手术时间和止血带使用时间不是 DVT 的显著危险因素。患者年龄（P<.0001）是深静脉血栓形成（DVT）的强烈危险因素。与接受单纯关节镜手术的患者相比，复杂手术-单侧（P<.005）或双侧（P<.0005）膝关节交叉韧带重建-导致术后 DVT 的发生率显著增加。
关节镜膝关节手术后通过静脉造影诊断的 VTE 总发生率为 14.9%，其中只有 3.7%的病例有症状，表明有 11.2%的无症状 VTE 病例。高龄和复杂的关节镜手术与 VTE 密切相关。
IV 级，预后病例系列。
