非骨折患者髋关节置换术前深静脉血栓形成的患病率及危险因素分析：1244 例回顾性研究
An analysis of the prevalence and risk factors of deep vein thrombosis in non-fracture patients awaiting total hip arthroplasty: a retrospective study of 1244 cases.
机构信息
State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, People's Republic of China.
出版信息
J Orthop Surg Res. 2024 Jan 22;19(1):84. doi: 10.1186/s13018-023-04488-9.
BACKGROUND
Deep vein thrombosis (DVT) has been one of the most dangerous complications in total hip arthroplasty (THA). If a patient's pre-surgical DVT is overlooked, it can easily be mistaken for a post-operative thrombus and lead to an increased risk of DVT during and after surgery. This retrospective study was to explore the incidence and associated risk factors of deep vein thrombosis (DVT) in non-fracture patients before total hip arthroplasty (THA).
METHODS
From September 2015 to September 2020, 1242 patients admitted for THA were enrolled with 1120 patients (90.2%) for primary THA and 122 patients (9.8%) for revision THA. An experienced sonographer performed a bedside ultrasound to detect DVT in bilateral lower limbs preoperatively. Univariate and logistic regression analysis was performed to identify the independent risk factors.
RESULTS
38 patients (3.1%) were detected with preoperative DVT. Univariate analysis showed that age (P < 0.001), D-dimer level (P = 0.002), female patients (P = 0.016), revision THA (P < 0.001), Barthel Index score (P = 0.010) were significantly associated with preoperative DVT. In subgroup comparison, the incidence of DVT increased with age significantly (P < 0.001) and D-dimer level (P < 0.001). In logistic regression analysis, age ≥ 75 years old (odds ratio [OR] 3.678, 95% CI [2.197-18.721], P < 0.001), gender (OR 2.709, 95% CI [1.244-5.896], P = 0.012), higher D-dimer ≥ 0.5 mg/l (OR 6.841, 95% CI [2.197-18.721], P < 0.001) and revision THA (OR 2.240, 95% CI [1.143-5.372], P = 0.05) were confirmed as the independent risk factors.
CONCLUSIONS
The incidence of preoperative DVT in non-fracture patients was 3.1%, with 2.4% in primary THA and 9.0% in revision THA. Age ≥ 75 years old, female, D-dimer ≥ 0.5 mg/l, and revision THA were independent risk factors. When evaluating the risk factors associated with thrombus formation preoperatively, it is important to take these into account before surgery.
背景
深静脉血栓（DVT）是全髋关节置换术（THA）中最危险的并发症之一。如果术前忽视了患者的 DVT，很容易将其误认为是术后血栓，从而增加手术中和手术后 DVT 的风险。本回顾性研究旨在探讨非骨折患者在全髋关节置换术（THA）前深静脉血栓（DVT）的发生率及相关危险因素。
方法
2015 年 9 月至 2020 年 9 月，共纳入 1242 例接受 THA 的患者，其中 1120 例（90.2%）为初次 THA，122 例（9.8%）为翻修 THA。由经验丰富的超声医师对双侧下肢进行术前床旁超声检查以检测 DVT。采用单因素和逻辑回归分析确定独立的危险因素。
结果
38 例（3.1%）患者术前发现 DVT。单因素分析显示，年龄（P<0.001）、D-二聚体水平（P=0.002）、女性患者（P=0.016）、翻修 THA（P<0.001）、Barthel 指数评分（P=0.010）与术前 DVT 显著相关。亚组比较发现，DVT 的发生率随年龄（P<0.001）和 D-二聚体水平（P<0.001）的升高而显著增加。逻辑回归分析显示，年龄≥75 岁（比值比[OR]3.678，95%可信区间[2.197-18.721]，P<0.001）、性别（OR 2.709，95%可信区间[1.244-5.896]，P=0.012）、较高的 D-二聚体≥0.5mg/l（OR 6.841，95%可信区间[2.197-18.721]，P<0.001）和翻修 THA（OR 2.240，95%可信区间[1.143-5.372]，P=0.05）是独立的危险因素。
结论
非骨折患者术前 DVT 的发生率为 3.1%，初次 THA 为 2.4%，翻修 THA 为 9.0%。年龄≥75 岁、女性、D-二聚体≥0.5mg/l 和翻修 THA 是独立的危险因素。在术前评估与血栓形成相关的危险因素时，术前应考虑这些因素。
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