内翻型膝关节骨关节炎行内侧开放楔形高位胫骨截骨术后深静脉血栓形成的发生率：一项回顾性研究
Incidence of deep venous thrombosis following medial opening-wedge high tibial osteotomy for varus knee osteoarthritis: a retrospective study.
作者信息
Zhang Shian, Ji Chenni, Liu Song, Tong Wenxue, Qin Ling, Zhu Yanbin
机构信息
Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, 999077, P. R. China.
Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, 050051, China.
出版信息
BMC Musculoskelet Disord. 2025 May 15;26(1):476. doi: 10.1186/s12891-025-08713-w.
PURPOSE
Deep venous thrombosis (DVT) is a common yet underexplored complication following medial opening-wedge high tibial osteotomy (MOWHTO) for medial compartment knee osteoarthritis. Existing studies report inconsistent findings due to methodological differences and patient heterogeneity. This study aims to determine the incidence and risk factors for DVT after MOWHTO.
METHODS
We retrospectively reviewed patients who underwent MOWHTO for medial compartment knee osteoarthritis with varus deformity between January 2019 and September 2023. Patients were classified into DVT and non-DVT groups based on Doppler ultrasonography findings. Univariate analysis was performed to compare demographics, lifestyle factors, comorbidities, surgical details, and laboratory results on postoperative day 1 between the DVT and non-DVT groups. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the predictive performance of laboratory indices for DVT. Multivariate logistic regression model identified independent risk factors for DVT.
RESULTS
Of the 421 patients (median age: 56 years, interquartile range: 52-61 years; 146 males), 55 (13.1%) developed postoperative DVT. The incidence rates for isolated calf muscle vein thrombosis (ICMVT), deep calf vein thrombosis (DCVT), and proximal DVT was 10.7%, 1.9% and 0.5%, respectively. Most laboratory indexes demonstrated non-significant (P > 0.05) or poor (AUC < 0.70) predictive performance, except for AT III and FDP (p = 0.022, 0.033, respectively). The multivariate logistic regression analyses showed female (OR, 2.23; 95% CI, 1.09 to 4.63), diabetes (OR, 2.47; 95% CI, 1.15 to 5.40) and hyperlipidemia (OR, 1.91; 95% CI, 1.14 to 3.68) were significantly associated with postoperative DVT.
CONCLUSION
This study identified a high incidence of DVT following MOWHTO and demonstrated that female sex, diabetes and hyperlipidemia were significant risk factors. These findings may inform better risk assessment, stratification and management of DVT.
CLINICAL TRIAL NUMBER
Not applicable.
目的
对于内侧间室膝关节骨关节炎行内侧开放楔形高位胫骨截骨术（MOWHTO）后，深静脉血栓形成（DVT）是一种常见但未得到充分研究的并发症。由于方法学差异和患者异质性，现有研究报告的结果不一致。本研究旨在确定MOWHTO术后DVT的发生率及危险因素。
方法
我们回顾性分析了2019年1月至2023年9月因内侧间室膝关节骨关节炎合并内翻畸形而接受MOWHTO的患者。根据多普勒超声检查结果将患者分为DVT组和非DVT组。进行单因素分析以比较DVT组和非DVT组之间的人口统计学、生活方式因素、合并症、手术细节以及术后第1天的实验室检查结果。采用受试者工作特征（ROC）曲线和曲线下面积（AUC）来评估实验室指标对DVT的预测性能。多因素逻辑回归模型确定DVT的独立危险因素。
结果
421例患者（中位年龄：56岁，四分位间距：52 - 61岁；男性146例）中，55例（13.1%）发生术后DVT。孤立性小腿肌肉静脉血栓形成（ICMVT）、小腿深静脉血栓形成（DCVT）和近端DVT的发生率分别为10.7%、1.9%和0.5%。除抗凝血酶III（AT III）和纤维蛋白降解产物（FDP）外（p分别为0.022、0.033），大多数实验室指标显示无显著（P>0.05）或较差（AUC<0.70）的预测性能。多因素逻辑回归分析显示女性（比值比[OR]，2.23；95%置信区间[CI]，1.09至4.63）、糖尿病（OR，2.47；95% CI，1.15至5.40）和高脂血症（OR，1.91；95% CI，1.14至3.68）与术后DVT显著相关。
结论
本研究发现MOWHTO术后DVT发生率较高，并表明女性、糖尿病和高脂血症是显著的危险因素。这些发现可能有助于更好地进行DVT的风险评估、分层和管理。
临床试验编号
不适用。
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