Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
J Thromb Haemost. 2015 Aug;13(8):1441-8. doi: 10.1111/jth.12996. Epub 2015 Jun 5.
From the currently available evidence, the risk of venous thrombosis after knee arthroscopy remains unclear.
To estimate the risk of venous thrombosis after arthroscopy of the knee, and to identify high-risk groups.
We used data from a large population-based case-control study (the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis [MEGA] study) on the etiology of venous thrombosis (4416 cases; 6150 controls). Odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex, body mass index, rheumatic disease, and regular exercise, were calculated.
One hundred and three patients and 24 controls had a knee arthroscopy in the year before the index date, resulting in a six-fold increased risk (OR 5.9, 95% CI 3.7-9.3). Ligament reconstructions led to a higher risk (OR 17.2, 95% CI 2.2-136) than meniscal surgery, diagnostic arthroscopy, or chondroplasty (OR 5.4, 95% CI 3.4-8.7). An additionally increased risk was found for combinations with genetic and acquired risk factors: with oral contraceptives (OR 46.6, 95% CI 6.1-353); and with factor V Leiden, factor II G20210A mutation, or non-O blood type (OR 15.3, 95% CI 8.1-28.5). The risk of venous thrombosis was particularly high in the first 3 months after knee arthroscopy, with an 18-fold increased risk (OR 16.2, 95% CI 7.8-33.7).
We observed a strongly increased risk of venous thrombosis after knee arthroscopy, especially in the first months after the procedure. The risk was particularly high in the presence of other acquired or genetic risk factors, making knee arthroscopy a high-risk intervention in certain individuals.
目前的证据表明，膝关节镜检查后发生静脉血栓栓塞的风险尚不清楚。
评估膝关节镜检查后静脉血栓栓塞的风险，并确定高危人群。
我们使用了一项基于人群的大型病例对照研究（静脉血栓形成病因的多环境和遗传评估[MEGA]研究）的数据，该研究共纳入 4416 例病例和 6150 例对照。采用比值比（OR）及其 95%置信区间（CI），调整年龄、性别、体重指数、风湿性疾病和规律运动等因素后进行计算。
103 例患者和 24 例对照在索引日期前一年接受了膝关节镜检查，其静脉血栓栓塞的风险增加了 6 倍（OR 5.9，95%CI 3.7-9.3）。与半月板手术、诊断性关节镜检查或软骨成形术相比，韧带重建导致的风险更高（OR 17.2，95%CI 2.2-136）。我们还发现，与遗传和获得性危险因素联合时，风险进一步增加：与口服避孕药（OR 46.6，95%CI 6.1-353）；以及因子 V Leiden、因子 II G20210A 突变或非 O 血型（OR 15.3，95%CI 8.1-28.5）。膝关节镜检查后 3 个月内静脉血栓栓塞的风险特别高，风险增加 18 倍（OR 16.2，95%CI 7.8-33.7）。
我们观察到膝关节镜检查后静脉血栓栓塞的风险显著增加，尤其是在手术后的头几个月。当存在其他获得性或遗传危险因素时，风险特别高，这使得膝关节镜检查成为某些个体的高风险干预措施。
