摘要
[目的]探讨全髋关节置换术(total hip arthroplasty,THA)后下肢深静脉血栓形成(deep vain thrombosis,DVT)的风险因素.[方法]回顾分析本院骨科2018年6月-2022年6月364例初次THA患者临床资料.依据术后临床与超声检查,将患者分为DVT组和非DVT组,比较两组资料,行二元多因素逻辑回归分析,依据逻辑分析结果构建预测列线图.采用受试者工作特征曲线分析评价列线图的预测效能.[结果]364患者中,72例患者发生DVT,占19.8％;另外292例患者未发生DVT,占80.2％.DVT组年龄、BMI、合并糖尿病、血栓史、手术时间、双侧置换比率和卧床时间均显著大于非DVT组(P＜0.05),但是,前者使用抗凝剂的比率显著低于后者(P＜0.05).逻辑分析表明,年龄≥70岁(OR=4.127,95％CI1.712～5.392,P=0.012)、BMI≥28 kg/m2(OR=2.916,95％CI 1.153～4.124,P=0.063)、糖尿病(OR=2.328,95％CI1.412～4.411,P=0.067)、既往血栓病史(OR=5.270,95％CI1.091～2.559,P=0.011)、手术时间≥120 min(OR=3.541,95％CI 1.215～4.089,P=0.027)、双侧置换(OR=2.286,95％CI 1.407～4.531,P=0.034)、术后卧床≥3d(OR=4.427,95％CI 1.136～1.973,P=0.023)是 DVT发生的危险因素;而使用抗凝药物是DVT发生的保护因素(OR=-2.019,95％CI-1.723～-5.802,P＜0.001).逻辑分析构建列线图预测模型并验证,ROC曲线下面积(AUC)为0.867(95％CI0.711～1.000).[结论]本研究筛选出高龄、糖尿病、血栓史、手术时间、双侧关节置换、卧床时间是全髋关节置换术后下肢深静脉血栓形成的相关因素,并构建了效果较好的列线图预测模型,可能为防治DVT提供参考.
Abstract
[Objective]To search the risk factors of deep vain thrombosis(DVT)after total hip arthroplasty(THA).[Methods]A retro-spective study was conducted on 364 patients who received initial THA in our hospital from June 2018 to June 2022.According to postopera-tive clinical and ultrasound examination,patients were divided into DVT group and non-DVT group.The data of the two groups were com-pared,and binary multi-factor logistic regression analysis was performed,and the prediction nomogram was constructed according to the re-sults of logical analysis.The predictive efficiency of the nomogram was evaluated by the receiver operating characteristic curve analysis.[Re-sults]Among 364 patients,72 had DVT,accounting for 19.8％,whereas the other 292 patients did not develop DVT,accounting for 80.2％.The DVT group proved significantly greater than the non-DVT group in terms of age,BMI,diabetes mellitus,history of thrombosis,operation time,bilateral replacement ratio and bed rest time(P＜0.05),but the former was significantly less than the latter regarding to the ratio of anti-coagulant usage(P＜0.05).As results of logical analysis,the age≥70 years(OR=4.127,95％CI 1.712～5.392,P=0.012),BMI≥28 years(OR=2.916,95％CI 1.153～4.124,P=0.063),diabetes mellitus(OR=2.328,95％CI 1.412～4.411,P=0.067),previous history of thrombosis(OR=5.270,95％CI 1.091～2.559,P=0.011),operation time ≥120 min(OR=3.541,95％CI 1.215～4.089,P=0.027),bilateral replacement(OR=2.286,95％CI 1.407～4.531,P=0.034),and postoperative bed rest ≥3 d(OR=4.427,95％CI 1.136～1.973,P=0.023)were the risk factor for DVT,whereas the use of anticoagulants was a protective factor for DVT(OR=-2.019,95％CI-1.723～-5.802,P＜0.001).A nomogram predic-tion model was created based on the logical regression outcome and verified by ROC with area under curve(AUC)of 0.867(95％CI 0.711～1.000).[Conclusion]In this study,advanced age,diabetes,previous thrombosis,operative time,bilateral joint replacement,and bed rest time were selected as the related factors for deep vein thrombosis after total hip arthroplasty,and a better predictive model was established,which may provide reference for the prevention and treatment of DVT.
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