多模式预防措施对老年关节置换术后静脉血栓栓塞症发生及转归的影响

doi:10.3877/cma.j.issn.2096-0263.2018.02.004

中华老年骨科与康复电子杂志 ›› 2018, Vol. 04 ›› Issue (02) : 80 -85. doi: 10.3877/cma.j.issn.2096-0263.2018.02.004

所属专题：文献；

深静脉血栓

多模式预防措施对老年关节置换术后静脉血栓栓塞症发生及转归的影响

黄子达¹, 张子杰², 李文波¹, 胡德庆¹, 林金銮¹, 张文明¹^,^†(

)

^1. 350005　福州，福建医科大学附属第一医院关节外科
^2. 350122　福州，福建医科大学研究生院

收稿日期:2017-10-05 出版日期:2018-04-05
通信作者: 张文明
基金资助:
福建省中青年教师教育科研项目(JAT170241)

Incidence and outcome of postoperative venous thromboembolism in elderly patients underwent knee or hip arthroplasty with multimodal thromboprophylaxis

Zida Huang¹, Zijie Zhang², Wenbo Li¹, Deqing Hu¹, Jinluan Lin¹, Wenming Zhang¹^,^†()

^1. Department of Orthopedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
^2. Graduate College of Fujian Medical University, Fuzhou 350122, China

Received:2017-10-05 Published:2018-04-05
Corresponding author: Wenming Zhang
About author:
Corresponding author: Zhang Wenming, Email: zhangwm0591@163.com

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引用本文：

黄子达, 张子杰, 李文波, 胡德庆, 林金銮, 张文明. 多模式预防措施对老年关节置换术后静脉血栓栓塞症发生及转归的影响[J/OL]. 中华老年骨科与康复电子杂志, 2018, 04(02): 80-85.

Zida Huang, Zijie Zhang, Wenbo Li, Deqing Hu, Jinluan Lin, Wenming Zhang. Incidence and outcome of postoperative venous thromboembolism in elderly patients underwent knee or hip arthroplasty with multimodal thromboprophylaxis[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2018, 04(02): 80-85.

目的

分析采用多模式血栓预防措施后，老年初次髋、膝关节置换术后静脉血栓栓塞症（VTE）的发生和转归情况。

方法

回顾性收集2015年1月至2017年6月行初次单侧髋、膝关节置换的老年患者375例（年龄≥60岁），所有患者均接受抗凝药物、足底小腿静脉气压泵、加强踝泵和早期下地等康复预防以及减少围手术期脱水等多模式血栓预防措施，术后采用彩色多普勒超声检查双侧下肢深静脉血栓（DVT）的发生情况，对有症状患者行肺动脉CT造影排查肺动脉栓塞（PE）。

结果

共349名患者获完整随访，随访率92.5%。随访期间无症状性PE，DVT共38例，总发生率为10.9%，均为远端DVT。手术同侧DVT 38例，双侧3例。症状性DVT共27例（27/38，71.1%），无症状性DVT 11例（11/38，29.0%）。单纯腓肠肌间静脉血栓29例，单条小腿静脉血栓3例，混合静脉血栓6例。接受不同手术方式的患者DVT发生率差别有统计学意义（χ²=0.000，P<0.001），其中接受全膝关节置换手术患者DVT的发生率为16.3%，显著高于单髁关节置换手术组的4.7%。单纯腓肠肌间静脉血栓未予药物治疗，其他DVT口服利伐沙班抗凝治疗4 w。术后8 w，有26例（26/38，68.4%）血栓完全消融，12例（12/38，31.6%）血栓未完全消融，但所有DVT相关临床表现均消失，无残留血栓后遗症，且无血栓进展或新发PE。

结论

采取多模式预防措施后，老年关节置换术后VTE发生率低，且均为远端DVT，经观察或短程抗凝治疗，症状消失并无后遗症。

关键词: 关节成形术，置换，髋, 关节成形术，置换，膝, 老年人, 静脉血栓形成, 多模式血栓预防

Objective

To analyze the incidence and outcome of postoperative venous thromboembolism in elderly patients underwent knee or hip arthroplasty with multimodal prophylaxis.

Methods

375 patients were enrolled retrospectively from January, 2015 to July, 2017. All the patients were older than 60 years and underwent unilateral primary knee or hip arthroplasty. A multimodal thromboprophylaxis program were employed, including low molecular heparin and Rivaroxaban for chemoprophylaxis, ankle pump, walking in early phase and pneumatic compression for physical prophylaxis. Color Doppler ultrasonography was used for screening the deep venous thrombosis (DVT) and CT pulmonary artery angiography was utilized for screening pulmonary embolism (PE). The follow-up was carried out for 8 weeks.

Results

349 patients had been fully followed up, the following rate was 92.5%. The overall VTE incidence was 10.9% (38/349), with no PE case and 38 distal DVT cases. There were 35 ipsilateral DVT cases and 3 bilateral cases. The incidence of symptomatic DVT was 71.1% (27/38) and asymptomatic was 29.0% (11/38). There were 29 cases with simple gastrocnemius venous thrombosis, 3 cases with calf vein thrombosis in one leg, and 6 cases with combined vein thrombosis. The DVT incidences in patients underwent different surgeries were significantly different (χ²=0.000, P<0.001). TKA group's DVT incidence is 16.3% much higher than UKA group. No medicine was held on those simple gastrocnemius venous thrombosis cases. The other DVT patients were prescribed Rivaroxaban for 4 weeks. All DVT patients were symptom-free and with no post-thrombotic syndrome or progressive DVT and PE.

Conclusions

With multimodal thromboprophylaxis, the overall VTE incidence in elderly underwent knee or hip arthroplasty is low and the presented ones were distal VTE. After short-term prognosis or short-term, symptoms disappeared with no sequela.

Key words: Arthroplasty, replacement, hip, Arthroplasty, replacement, knee, Aged, Venous thrombosis, Multimodal thromboprophylaxis

表1 DVT组与无DVT组老年关节置换患者的人口学特征

组别	例数	年龄（岁，±s）	男性比例[例（%）]	身体质量指数（kg/m²，±s）
DVT组	38	72±8	9（23.7）	26.7±2.5
无DVT组	311	71±7	96（30.9）	27.0±2.6
统计值	?	t=0.497	χ²=0.831	t=0.674
P值	?	0.627	0.455	0.501

表1 DVT组与无DVT组老年关节置换患者的人口学特征

组别	例数	年龄（岁，±s）	男性比例[例（%）]	身体质量指数（kg/m²，±s）
DVT组	38	72±8	9（23.7）	26.7±2.5
无DVT组	311	71±7	96（30.9）	27.0±2.6
统计值	?	t=0.497	χ²=0.831	t=0.674
P值	?	0.627	0.455	0.501

表2 不同关节置换手术方式DVT发生情况的比较

手术方式	例数	DVT[例（%）]
TKA	166	27（16.3）
UKA	43	2（4.7）
HHA	21	1（4.8）
THA	119	8（6.7）
χ²值	?	0.000
P值	?	<0.001*

表2 不同关节置换手术方式DVT发生情况的比较

手术方式	例数	DVT[例（%）]
TKA	166	27（16.3）
UKA	43	2（4.7）
HHA	21	1（4.8）
THA	119	8（6.7）
χ²值	?	0.000
P值	?	<0.001*

表3 不同DVT受累静脉的症状情况比较

DVT受累静脉	例数	症状[例（%）]
DVT受累静脉	例数	有症状	无症状
单纯腓肠肌间静脉血栓	29	7（24.1）	22（75.9）
单条小腿静脉血栓	3	1（33.3）	2（66.7）
混合静脉血栓	6	3（50.0）	3（50.0）
χ²值	?	0.465*
P值	?	0.439

表3 不同DVT受累静脉的症状情况比较

DVT受累静脉	例数	症状[例（%）]
DVT受累静脉	例数	有症状	无症状
单纯腓肠肌间静脉血栓	29	7（24.1）	22（75.9）
单条小腿静脉血栓	3	1（33.3）	2（66.7）
混合静脉血栓	6	3（50.0）	3（50.0）
χ²值	?	0.465*
P值	?	0.439

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