前交叉韧带重建术后深静脉血栓形成和肺栓塞的发生率：一项系统评价。
Rates of Deep Venous Thrombosis and Pulmonary Embolus After Anterior Cruciate Ligament Reconstruction: A Systematic Review.
作者信息
Erickson Brandon J, Saltzman Bryan M, Campbell Kirk A, Fillingham Yale A, Harris Joshua D, Gupta Anil K, Bach Bernard R
机构信息
Rush University Medical Center, Chicago, Illinois.
出版信息
Sports Health. 2015 May;7(3):261-6. doi: 10.1177/1941738115576927.
CONTEXT
Venous thromboembolic (VTE) disease is thought to be an uncommon but serious problem after anterior cruciate ligament (ACL) reconstruction. Rates of VTE after ACL reconstruction are not well documented.
OBJECTIVE
To determine the rates of deep vein thrombosis (DVT) and symptomatic pulmonary emboli (PE) after ACL reconstruction.
DATA SOURCES
Five publicly available databases (PubMed, Cochrane Database of Systematic Reviews, Scopus, Embase, and CINAHL Complete) were utilized.
STUDY SELECTION
All studies that screened patients for DVT and reported rates of DVT and PE after ACL reconstruction were eligible for inclusion. Level 5 evidence, cadaver, biomechanical, and basic science studies; studies reporting only multiligament reconstruction outcomes; studies where rates of DVT and PE could not be separated out from patients undergoing other types of arthroscopic knee procedures; and classification studies were excluded.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 4.
DATA EXTRACTION
All study, subject, and surgical data were analyzed. Descriptive statistics were calculated.
RESULTS
Six studies met the inclusion criteria, with a mean Modified Colman Methodology Score of 30 ± 8.22. A total of 692 patients (488 men [70.5%]; mean age, 31.6 ± 2.82 years; mean follow-up, 7 ± 18.4 months) underwent ACL reconstruction using either semitendinosus-gracilis autograft (77.6%), bone-patellar tendon-bone (BTB) autograft (22%), or allograft (0.4%). No patient received postoperative pharmacological anticoagulation. Fifty-eight patients (8.4%) had a DVT (81% below knee and 19% above knee), while only 1 patient (0.2%) had a symptomatic PE. When reported, 27% of DVT episodes were symptomatic.
CONCLUSION
The rate of DVT after ACL reconstruction in patients who did not receive postoperative pharmacological anticoagulation is 8.4%, while the rate of symptomatic PE is 0.2%. Of the DVT episodes that occurred, 73% were asymptomatic.
背景
静脉血栓栓塞（VTE）疾病被认为是前交叉韧带（ACL）重建术后一种不常见但严重的问题。ACL重建术后VTE的发生率尚无充分记录。
目的
确定ACL重建术后深静脉血栓形成（DVT）和有症状肺栓塞（PE）的发生率。
数据来源
使用了五个可公开获取的数据库（PubMed、Cochrane系统评价数据库、Scopus、Embase和CINAHL Complete）。
研究选择
所有对患者进行DVT筛查并报告ACL重建术后DVT和PE发生率的研究均符合纳入标准。排除5级证据、尸体、生物力学和基础科学研究；仅报告多韧带重建结果的研究；无法将DVT和PE发生率与接受其他类型膝关节镜手术的患者区分开来的研究；以及分类研究。
研究设计
系统评价。
证据级别
4级。
数据提取
分析了所有研究、受试者和手术数据。计算了描述性统计数据。
结果
六项研究符合纳入标准，改良科尔曼方法评分的平均值为30±8.22。共有692例患者（488例男性[70.5%]；平均年龄31.6±2.82岁；平均随访7±18.4个月）接受了ACL重建，采用半腱肌-股薄肌自体移植物（77.6%）、骨-髌腱-骨（BTB）自体移植物（22%）或同种异体移植物（0.4%）。没有患者接受术后药物抗凝治疗。58例患者（8.4%）发生DVT（81%位于膝关节以下，19%位于膝关节以上），而只有1例患者（0.2%）发生有症状的PE。报告显示，27%的DVT发作有症状。
结论
未接受术后药物抗凝治疗的患者ACL重建术后DVT发生率为8.4%，有症状PE发生率为0.2%。在发生的DVT发作中，73%无症状。
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