| 孙官军,李清山,银毅,等.膝关节镜日间手术静脉血栓栓塞的发生率及危险因素分析[J].安徽医药,2025,29(3):524-529. |
| 膝关节镜日间手术静脉血栓栓塞的发生率及危险因素分析 |
| Incidence and risk factors of venous thromboembolism in knee arthroscopic day surgery |
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| DOI：10.3969/j.issn.1009-6469.2025.03.018 |
| 中文关键词: 关节镜检查 膝关节 手术后并发症 日间手术 静脉血栓栓塞 危险因素 |
| 英文关键词: Arthroscopy Knee joint Postoperative complications Day surgery Venous thromboembolism Risk factors |
| 基金项目:四川省医学会(恒瑞)科研基金专项科研课题项目( 2021HR34) |
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| 中文摘要: |
| 目的研究膝关节镜日间手术静脉血栓栓塞( VTE)的发生率，探讨其发生的相关危险因素。方法回顾性研究，连续纳入 2022年 1月至 2023年 7月遂宁市中心医院接受单侧膝关节镜日间手术且符合纳入及排除标准的 1 019例病人，其中男 558例，女 461例，年龄范围 8~74岁。术前彩超排除下肢静脉血栓，术后第 1天复查下肢血管超声后出院，如有血栓则转诊血管外科。根据术后超声将病人分为 VTE组和非 VTE组，统计术后 VTE发生率，采用单因素及二元多重 logistic回归分析 VTE发生的危险因素。结果 1 019例日间手术病人中 128例 12.56%(128/1 019)出现 VTE。其中肺栓塞 1例 0.10％(1/1 019)，近端深静脉血栓(DVT)病人 4例 0.39%(4/1 019)，远端 DVT病人 123例 12.07%(123/1 019)。术后分析结果显示，女性、年龄增大、胆固醇增高、高脂血症、脑梗死病史、下肢静脉曲张、手术时间长、手术术式是影响发生血栓的独立危险因素( OR>1)。相较于关节清理术，关节镜腘窝囊肿切除术，前交叉韧带( ACL)重建术，后交叉韧带( PCL)重建术病人发生血栓的概率明显升高，其 OR值分别为 45.30，3.62，4.87。结论膝关节镜日间手术后 VTE的发生率为 12.56%，主要为远端 DVT(12.07%)。女性、年龄增大、胆固醇增高、高脂血症、脑梗死病史、下肢静脉曲张、手术时间长、手术方式是发生血栓的危险因素。相较于关节清理术，关节镜腘窝囊肿切除术， ACL重建术和 PCL重建术血栓形成风险明显增高。 |
| 英文摘要: |
| Objective To examine the prevalence of venous thromboembolism (VTE) in knee arthroscopic day surgery and to analyze the related risk factors.Methods A retrospective study was conducted of 1019 patients who underwent unilateral arthroscopic day sur-gery at Suining Central Hospital from January 2022 to July 2023 and met the inclusion and exclusion criteria of the study. The patientcohort comprised 558 males and 461 females, with ages ranging from 8 to 74 years. Preoperative Doppler ultrasound was conducted toexclude the presence of venous thrombus embolism (VTE) in the lower extremities, followed by postoperative vascular ultrasound exami-nation of the lower limbs on the first day after the surgical procedure. In the absence of VTE, patients were discharged, while those withVTE were referred to vascular surgery for further management. Subsequently, the patients were categorized into either the VTE group orthe non-VTE group based on the findings from postoperative ultrasonography, allowing for the calculation of VTE incidence. To identifythe risk factors associated with VTE, univariate and multivariate logistic regression analyses were performed on binary outcome vari-ables. Results Among the 1 019 patients, 128 cases (12.56%, 128/1 019) developed VTE. This comprised of 1 (0.10％, 1/1 019) caseof pulmonary embolism, 4 (0.39%, 4/1 019) cases of proximal deep vein thrombosis (DVT), and 123 (12.07%, 123/1 019) cases of distalDVT. Subsequent analysis conducted postoperatively indicated that female gender, advanced age, elevated cholesterol levels (CHOL),presence of hyperlipidemia, history of cerebral infarction, lower extremity varicose veins, longer duration of operation, and the specificsurgical procedure performed were identified as independent risk factors for thrombosis (OR> 1). Patients who underwent arthroscopicpopliteal cyst resection, anterior cruciate ligament (ACL) reconstruction, and posterior cruciate ligament (PCL) reconstruction exhibiteda significantly higher likelihood of thrombosis when compared to those who underwent joint debridement, as indicated by odds ratios(OR) of 45.30, 3.62, and 4.87, respectively.Conclusions The occurrence of VTE following knee arthroscopic day surgery was found tobe 12.56%, with distal DVT accounting for the majority at 12.07%. Several factors were identified as significant risk factors for throm-bosis, including being female, older age, higher cholesterol level, hyperlipidemia, history of cerebral infarction, lower extremity varicoseveins, longer duration of surgery, and specific surgical procedures. Notably, patients undergoing arthroscopic popliteal cyst resection, ACL reconstruction, and PCL reconstruction have a significantly higher risk of thrombosis compared to those undergoing joint debride-ment. |
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