腰椎退行性改变导致的髂静脉压迫综合征与全膝关节置换术后深静脉血栓形成有关。
Iliac vein compression syndrome by lumbar degenerative changes is associated with deep vein thrombosis after total knee arthroplasty.
机构信息
Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, 05278, Seoul, Republic of Korea.
Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 06591, Seoul, Republic of Korea.
出版信息
Arch Orthop Trauma Surg. 2023 Sep;143(9):5833-5842. doi: 10.1007/s00402-023-04811-3. Epub 2023 Feb 17.
INTRODUCTION
This study aimed to identify whether iliac vein compression syndrome(IVCS) is associated with deep vein thrombosis(DVT) after total knee arthroplasty(TKA) and whether lower lumbar degenerative changes were risk factors for IVCS.
MATERIALS AND METHODS
A total of 259 consecutive patients who underwent TKA from January 2019 to March 2022 was retrospectively reviewed. Preoperative plain radiographs of lumbar spines and CT venography (CTV) for DVT diagnosis at postoperative 7 days were performed in all patients. Imaging findings of lower lumbar degenerative changes were analyzed on plain radiograph including lateral osteophytes, scoliosis, lateralolisthesis, retrolisthesis, anterolisthesis, and lower lumbar lordosis angle (LLLA). Percent compression at the left common iliac vein (LCIV) and right common iliac vein (RCIV) as well as DVT were evaluated on CTV. Moreover, IVCS was defined as greater than 50% of compression of the iliac vein on CTV.
RESULTS
DVT occurred in 79 patients (30.5%) after TKA. The overall occurrence of DVT was significantly higher in patients with IVCS of LCIV (52.8%) than those without (18.8%, P < 0.001). When DVT was further subdivided, compared to non-IVCS, IVCS of LCIV was significantly associated with bilateral DVT (P < 0.001, both), especially distal DVT (P < 0.001, both), and IVCS of RCIV was significantly associated with right-side DVT (P = 0.031), especially popliteal (P = 0.008) and distal DVT(P = 0.011). Female patients (OR: 3.945, P = 0.039), presence of left osteophyte (OR: 2.348, P = 0.006), and higher LLLA (OR: 1.082, P < 0.001) were significantly associated with IVCS of LCIV, and presence of right osteophyte (OR: 3.494, P = 0.017) was significantly associated with IVCS of RCIV.
CONCLUSION
IVCS was significantly associated with DVT after TKA and lumbar degenerative changes with lateral osteophytes and hyperlordosis were significant risk factors for IVCS.
简介
本研究旨在确定髂静脉压迫综合征（IVCS）是否与全膝关节置换术后深静脉血栓形成（DVT）有关，以及下腰椎退行性变化是否为 IVCS 的危险因素。
材料与方法
回顾性分析 2019 年 1 月至 2022 年 3 月期间行全膝关节置换术的 259 例连续患者。所有患者均行腰椎正位片和术后 7 天的 CT 静脉造影（CTV）以诊断 DVT。分析腰椎正位片上的下腰椎退行性变化的影像学表现，包括侧方骨赘、脊柱侧凸、侧方滑脱、退行性后滑脱、退行性前滑脱和下腰椎前凸角（LLLA）。在 CTV 上评估左髂总静脉（LCIV）和右髂总静脉（RCIV）的受压百分比以及 DVT。此外，IVCS 定义为 CTV 上髂静脉受压大于 50%。
结果
79 例（30.5%）患者在 TKA 后发生 DVT。LCIV 的 IVCS 患者（52.8%）总体 DVT 发生率明显高于无 IVCS 患者（18.8%，P<0.001）。当进一步将 DVT 细分时，与非-IVCS 相比，LCIV 的 IVCS 与双侧 DVT（均 P<0.001），特别是远端 DVT（均 P<0.001）显著相关，RCIV 的 IVCS 与右侧 DVT（P=0.031），特别是腘静脉（P=0.008）和远端 DVT（P=0.011）显著相关。女性患者（OR：3.945，P=0.039）、左侧骨赘存在（OR：2.348，P=0.006）和较高的 LLLA（OR：1.082，P<0.001）与 LCIV 的 IVCS 显著相关，右侧骨赘存在（OR：3.494，P=0.017）与 RCIV 的 IVCS 显著相关。
结论
IVCS 与 TKA 后 DVT 显著相关，外侧骨赘和高前凸是 IVCS 的显著危险因素。
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