膝关节镜术后VTE的发生率及其抗凝策略分析

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Abstract Objective The incidence of symptomatic venous thrombo embolism(VTE) after knee arthroscopy is uncertain.To determine the incidence，anatomical distribution of venous thrombo embolism(VTE) in limbs undergoing elective unilateral knee arthroscopy without active pharmacologic prophylaxis，to quantify the impact of risk factors on its incidence，and to evaluate the necessity of active pharmacologic prophylaxis in patients undergoing arthroscopic surgery. Methods A retrospective cohort study of elective arthroscopic knee procedures during a twelve-month period(January 1，2015 to December 31，2015) was performed in our department of orthopedics.There were 400 patients who had elective arthroscopic knee procedures.270 were male，and 130 were female，with a mean age of(38 ± 15.2) years.The mean duration of the operation was(55 ± 21) minutes.The patients undergoing elective knee arthroscopy received general physical prophylaxis，but did not receive any kind of chemoprophylaxis.During 6 weeks post surgery，all patients having arthroscopy in our institution were routinely examined.Clinical signs of VTE were checked and recorded，and the occurrence of symptomatic deep venous thrombosis(DVT) or pulmonary embolism(PE) within 6 weeks after surgery was identified by duplex ultrasonography or pulmonary arteriography.The general risk factors of VTE were also analyzed.Results During 6 weeks post surgery，symptomatic DVT was detected in 4(1%) patients.Of these，1 was proximal，and 3 were distal.No patient died and no patient presented with clinically suspected PE.The risk of VTE was significantly higher among patients who had a tourniquet applied for more than 60 minutes or older than 60 years.Conclusion The incidence of symptomatic VTE after arthroscopic knee surgery is very low.Routine pharmacological prophylaxis to prevent symptomatic venous thromboembolism is likely not needed in this patient population.Older age and operation time are associated with increased risk.A specific highrisk group for the development of VTE should be identified and received effective prophylaxis.

Key words： knee arthroscopy venous thromboembolism incidence

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