摘要
目的比较分析全膝关节置换术(TKA)和单髁关节置换术(UKA)围手术期D-二聚体动态监测的临床价值。方法回顾性分析2018年1月至2024年8月开封市中心医院骨科收治的549例膝骨性关节炎(KOA)患者的临床资料,其中TKA组324例[男138例,女186例,年龄(68.2±7.9)岁],UKA组225例[男123例,女102例,年龄(62.4±8.5)岁]。收集术前及术后第1、4、7、14、21天D-二聚体检测值(μg/ml)及静脉血栓栓塞症(VTE)发生情况。组间比较采用独立样本t检验(D-二聚体含量)和卡方检验(VTE发生率、D-二聚体≥2μg/ml阳性率),时间趋势分析采用Cochran-Armitage趋势检验。数据以均数±标准差(D-二聚体)或百分比(VTE发生率、阳性率)表示。结果D-二聚体动态变化:TKA组术后第1天D-二聚体峰值高于UKA组[(4.9±1.2)μg/ml比(2.6±0.8)μg/ml,t=28.43,P<0.01]。两组术后D-二聚体水平均随时间呈下降趋势(TKA组:Cochran-Armitage趋势检验χ^(2)=37.17,P<0.01;UKA组:Cochran-Armitage趋势检验χ^(2)=6.86,P<0.05);TKA组术后第1天D-二聚体≥2μg/ml阳性率高于UKA组[17.9%(58/324)比12.0%(27/225),χ^(2)=2.89,P<0.05]。VTE发生率:TKA组术后第4天VTE发生率高于UKA组[30.2%(98/324)比19.1%(43/225),χ^(2)=7.35,P<0.05],两组术后VTE发生率均随时间呈下降趋势(TKA组:Cochran-Armitage趋势检验χ^(2)=112.32,P<0.01;UKA组:Cochran-Armitage趋势检验χ^(2)=48.75,P<0.01)。结论TKA术后凝血激活程度显著高于UKA,D-二聚体动态监测可有效反映术后凝血状态变化,且两组术后VTE发生率均随时间下降至安全范围,提示围手术期抗凝治疗对降低VTE风险具有重要意义。
Objective To compare the clinical value of dynamic D-dimer monitoring during the perioperative period between total knee arthroplasty(TKA)and unicompartmental knee arthroplasty(UKA).Methods A retrospective analysis was performed on 549 patients with knee osteoarthritis(KOA)treated at Kaifeng Central Hospital from January 2018 to August 2024.The study included 324 TKA patients[138 males,186 females;age:(68.2±7.9)years]and 225 UKA patients[123 males,102 females;age:(62.4±8.5)years].D-dimer levels(μg/ml)and venous thromboembolism(VTE)incidence were collected preoperatively and on postoperative days 1,4,7,14,and 21.Independent sample t-tests were used for intergroup comparisons of D-dimer levels,while chi-square tests evaluated VTE incidence and D-dimer≥2μg/ml positive rates.Cochran-Armitage trend tests were used to analyze temporal trends.Data were expressed as mean±standard deviation(D-dimer)or percentages(VTE incidence,positive rates),with statistical significance defined as P<0.05.Results TKA patients showed a significantly higher postoperative peak D-dimer level on day 1[(4.9±1.2)μg/ml]than UKA patients[(2.6±0.8)μg/ml,t=28.43,P<0.01].Both groups demonstrated decreasing D-dimer trends over time(TKA:χ^(2)=37.17,P<0.01;UKA:χ^(2)=6.86,P<0.05).TKA patients had a significantly higher day-1 positive rate(17.9%)than UKA patients(12.0%,χ^(2)=2.89,P<0.05).TKA patients had the highest VTE incidence on day 4(30.2%),significantly higher than UKA patients(19.1%,χ^(2)=7.35,P<0.05).VTE incidence decreased significantly over time in both groups(TKA:χ^(2)=112.32,P<0.01;UKA:χ^(2)=48.75,P<0.01),with no significant intergroup differences on days 14 and 21(P>0.05).Conclusion TKA induces significantly greater perioperative coagulation activation than UKA,and dynamic D-dimer monitoring effectively reflects postoperative coagulation status changes.Although TKA patients exhibit higher early VTE risk,both groups achieve safe VTE rates by postoperative day 21,highlighting the critical role of perioperative anticoagulation in reducing thrombotic complications.
作者
王成军
马守战
Wang Chengjun;Ma Shouzhan(Department of Orthopedics,Kanfeng Central Hospital,Kaifeng 475000,China)
出处
《中华实验外科杂志》
2025年第4期752-754,共3页
Chinese Journal of Experimental Surgery
