CAJ | 학술논문

目的：探讨下肢关节置换术后下肢深静脉血栓形成（DVT）的影响因素，并有针对性地提出临床防治对策。方法采用病例对照研究方法，选取医院2011年1月至2014年1月行全膝关节置换术与全髋关节置换术术后下肢DVT的患者106例作为研究对象( DVT组)，选取同期行上述关节置换术术后无下肢DVT的120例患者为对照组(非DVT组)，通过单因素分析及Logistic回归模型探求下肢关节置换术后发生下肢DVT的独立影响因素。结果单因素分析表明，DVT组与非DVT组在年龄、体重指数、是否糖尿病患者、凝血指标是否异常、手术类型、置换关节数、假体类型、术中出血量及术后机械抗凝类型等指标构成差异显著（ P<0.05）。Logistic逐步回归模型显示年龄60岁以上、手术类型（全膝关节置换术）、合并糖尿病(、凝血指标异常、使用骨水泥型假体、术后物理抗凝类型(未使用下肢血液循环泵)等指标是术后下肢DVT的独立危险因素（ P<0.05）。结论高龄、凝血功能异常、手术类型、糖尿病、假体类型、术后物理抗凝类型是下肢关节置换术后下肢DVT的独立危险因素，针对这些因素强化术前辅助检查与评估、术后监测与积极预防性抗凝治疗是预防下肢DVT的必要和有效措施。
목적：탐토하지관절치환술후하지심정맥혈전형성（DVT）적영향인소，병유침대성지제출림상방치대책。방법채용병례대조연구방법，선취의원2011년1월지2014년1월행전슬관절치환술여전관관절치환술술후하지DVT적환자106례작위연구대상( DVT조)，선취동기행상술관절치환술술후무하지DVT적120례환자위대조조(비DVT조)，통과단인소분석급Logistic회귀모형탐구하지관절치환술후발생하지DVT적독립영향인소。결과단인소분석표명，DVT조여비DVT조재년령、체중지수、시부당뇨병환자、응혈지표시부이상、수술류형、치환관절수、가체류형、술중출혈량급술후궤계항응류형등지표구성차이현저（ P<0.05）。Logistic축보회귀모형현시년령60세이상、수술류형（전슬관절치환술）、합병당뇨병(、응혈지표이상、사용골수니형가체、술후물리항응류형(미사용하지혈액순배빙)등지표시술후하지DVT적독립위험인소（ P<0.05）。결론고령、응혈공능이상、수술류형、당뇨병、가체류형、술후물리항응류형시하지관절치환술후하지DVT적독립위험인소，침대저사인소강화술전보조검사여평고、술후감측여적겁예방성항응치료시예방하지DVT적필요화유효조시。
Objective To investigate the influencing factors of lower extremity deep venous thrombosis ( DVT ) after lower extremity re-placement and to pertinently put forward the clinical countermeasure of prevention and treatment. Methods The case control study method was adopted. 106 patients with lower extremity DVT after total knee replacement ( TKR ) and total hip replacement ( THR ) in our hospital from January 2011 to January 2014 were selected as the research subjects ( DVT group ) , and contemporaneous 120 cases of above arthroplasty without lower extremity DVT were selected as the control group. The independent influencing factors for the occur-rence of lower extremity DVT were investigated by the single factor analysis and the logistic regression model. Results The single fac-tor analysis showed that the DVT group and the contrd group were obviously different from each other in the age, body mass index, complicating diabetes, coagulation abnormalities, operation type, joint replacement numbers, prosthesis type, intraoperative bleeding volume, postoperative mechanical anticoagulation type ( P < 0. 05 ) . The stepwise logistic regression model showed that the age above 60 years, type of operation, complicating diabetes mellitus, abnormal coagulation indexes, use of bone cement prosthesis and postoperative physical anticoagulation type ( without use of lower limb blood circulation pump ) were the independent risk factors for lower extremity DVT oc-currence ( P < 0. 05 ) . Conclusion Advanced age, coagulation abnormalities, operation type, diabetes mellitus, type of prosthesis and post-operative physical anticoagulation type are the independent risk factors for the occurrence of lower extremity DVT after lower limb arthroplasty, aiming at above factors, strengthening the preoperative auxiliary examination and evaluation, postoperative monitoring and ac-tively preventive anticoagulation therapy are necessary and effective measures for preventing lower extremity DVT.