Na Sang-Soo, Kim Du-Han, Choi Byung-Chan, Cho Chul-Hyun
Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea.
Int Orthop. 2022 Sep;46(9):2081-2088. doi: 10.1007/s00264-022-05496-w. Epub 2022 Jun 28.
The purpose of this study was to investigate the incidence, characteristics, and risk factors for venous thromboembolism (VTE) in patients who underwent shoulder arthroplasty (SA) through systematic review.
A search of studies was conducted using the databases for PubMed, EMBASE, Scopus, Ovid, MEDLINE, and Cochrane Library according to the guidelines for PRISMA (Preferred Reporting Items for Systematic Meta-Analyses). Quality assessment was performed using the Methodological Index for Nonrandomized Studies (MINORS).
Nine studies (12,566 shoulders) were finally eligible and the mean MINORS score was 13.2 (ranges, 9-18). The overall incidence of VTE was 0.81% (78/9681) including 0.54% (52/9681) for deep vein thrombosis (DVT) and 0.33% (42/12,566) for pulmonary embolism (PE). There were no significant differences in the incidences according to the type of arthroplasty. DVT was detected at an average of 18.8 days after index surgery, and PE was detected at an average of 12.7 days after index surgery. The risk factors for VTE included age older than 70 years, higher BMI, raised Charlson Comorbidity Index, history of DVT, asthma, cardiac arrhythmia, diabetes, lower haemoglobin level, use of general endotracheal anaesthesia without interscalene nerve block, traumatic indication, longer operative time, and revision SA. The mortality rate was 4.1% (2/49) for VTE and 8.3% (2/24) for PE.
Despite the fact that the overall incidence of VTE following SA was as low as 0.81%, shoulder surgeons should consider the potential for this serious complication in high-risk patients. Further well-designed large-scale studies are necessary to clarify the consensus for VTE after SA including risk factors, treatment, and prophylaxis.
本研究旨在通过系统评价，调查接受肩关节置换术（SA）患者静脉血栓栓塞症（VTE）的发生率、特征及危险因素。
根据PRISMA（系统评价和Meta分析优先报告条目）指南，使用PubMed、EMBASE、Scopus、Ovid、MEDLINE和Cochrane图书馆数据库检索研究。采用非随机研究方法学指数（MINORS）进行质量评估。
最终纳入9项研究（12,566例肩关节），MINORS评分均值为13.2（范围9 - 18）。VTE总发生率为0.81%（78/9681），其中深静脉血栓形成（DVT）发生率为0.54%（52/9681），肺栓塞（PE）发生率为0.33%（42/12,566）。根据关节置换类型，发生率无显著差异。DVT平均在初次手术后18.8天被检测到，PE平均在初次手术后12.7天被检测到。VTE的危险因素包括年龄大于70岁、较高的体重指数、较高的Charlson合并症指数、DVT病史、哮喘、心律失常、糖尿病、较低的血红蛋白水平、使用全身气管内麻醉且未行肌间沟神经阻滞、创伤性指征、较长的手术时间以及翻修肩关节置换术。VTE的死亡率为4.1%（2/49），PE的死亡率为8.3%（2/24）。
尽管肩关节置换术后VTE的总体发生率低至0.81%，但肩关节外科医生应考虑高危患者发生这种严重并发症的可能性。需要进一步设计良好的大规模研究，以明确肩关节置换术后VTE的共识，包括危险因素、治疗和预防。
