直接前路与后外侧入路全髋关节置换术后血栓形成风险的对比研究

Comparison of thrombosis risk after total hip arthroplasty via direct anterior and posterolateral approaches

摘要:

目的 探讨直接前路（DAA）与后外侧入路（PLA）全髋关节置换术后，凝血酶-抗凝血酶复合物（TAT）、纤溶酶-α2纤溶酶复合物（PIC）、血栓调节蛋白（TM）的表达水平，并评估其在血栓形成风险中的预测价值。方法 选取2022年7月—2023年7月在湖南中医药大学附属益阳市中心医院因股骨颈骨折行髋关节置换手术的40例患者，并分为后外侧入路组（PLA组）与直接前方入路组（DAA组），分别有25和15例。比较两组患者一般资料、手术时间、术中出血量，检测凝血相关标志物TAT、PIC、TM在的表达水平，通过受试者工作特征（ROC）曲线分析其在全髋关节置换术后血栓形成风险评估中的预测价值。结果 两组患者一般资料比较，差异均无统计学意义（P >0.05）。DAA组手术时间长于PLA组（P <0.05），手术出血量少于PLA组（P <0.05）。两组患者术前及术后1、3和5 d的TAT、PIC、TM值比较，结果 ①不同时间点TAT、PIC、TM比较，差异均有统计学意义（P <0.05）；②两组患者TAT、PIC、TM比较，差异均有统计学意义（P <0.05），DAA组TAT、PIC、TM较低，提示血栓形成风险相对较小；③两组患者TAT、PIC、TM变化趋势比较，差异均有统计学意义（P <0.05）。ROC曲线分析结果示，血清TAT、PIC、TM及其联合预测全髋关节置换术后血栓形成的曲线下面积分别为0.831（95% CI：0.688，0.973）、0.707（95% CI：0.540，0.873）、0.756（95% CI：0.588，0.924）、0.851（95% CI：0.710，0.992），敏感性分别为80.0%（95% CI：0.676，0.924）、66.7%（95% CI：0.521，0.813）、73.3%（95% CI：0.597，0.869）、80.0%（95% CI：0.676，0.924），特异性分别为64.0%（95% CI：0.491，0.789）、60.0%（95% CI：0.448，0.752）、68.0%（95% CI：0.535，0.825）、72.0%（95% CI：0.581，0.859），3项指标联合预测价值更高。结论 DAA入路手术血栓形成风险相对较低。TAT、PIC、TM联合检测在全髋关节置换术后血栓形成风险评估中具有更高的预测价值。

Abstract:

Methods Forty patients with femoral neck fractures who underwent hip arthroplasty at Yiyang Central Hospital Affiliated to Hunan University of Traditional Chinese Medicine from July 2022 to July 2023 were included and divided into the PLA group (n = 25) and the DAA group (n = 15). The general characteristics, operative duration and intraoperative blood loss were compared between the two groups. The levels of coagulation-related markers TAT, PIC, and TM were measured, and their predictive value was analyzed using the receiver operating characteristic (ROC) curve.Results There was no difference in the general characteristics between the two groups (P > 0.05). The operative duration in the DAA group was longer than that in the PLA group (P < 0.05), and the intraoperative blood loss in the DAA group was less than that in the PLA group (P < 0.05). Comparison of the TAT, PIC, and TM values of the DAA group and the PLA group before surgery and 1, 3, and 5 d after surgery showed that they were different among the time points (P < 0.05) and between the groups (P < 0.05), with the DAA group having lower TAT, PIC, and TM values, indicating a relatively lower risk of thrombosis. Besides, there were statistically significant differences in the change trends of TAT, PIC, and TM values between the two groups (P < 0.05). The ROC curve analysis indicated that the areas under the curves of TAT, PIC, TM, and their combination for predicting thrombosis after total hip arthroplasty were 0.831 (95% CI: 0.688, 0.973), 0.707 (95% CI: 0.540, 0.873), 0.756 (95% CI: 0.588, 0.924) and 0.851 (95% CI: 0.710, 0.992), with the sensitivities being 80.0% (95% CI: 0.924, 0.676), 66.7% (95% CI: 0.813, 0.521), 73.3% (95% CI: 0.869, 0.597), and 80.0% (95% CI: 0.676, 0.924), and the specificities being 64.0% (95% CI: 0.491, 0.789), 60.0% (95% CI: 0.448, 0.752), 68.0% (95% CI: 0.535, 0.825), and 72.0% (95% CI: 0.581, 0.859). The combination of the three markers yielded a higher predictive value.Conclusions The risk of thrombosis is relatively lower with the DAA. Combined detection of TAT, PIC, and TM offers greater predictive value in assessing the risk of thrombosis after total hip arthroplasty.Objctive To explore the expression levels of coagulation-related markers TAT, PIC, and TM after total hip arthroplasty via the direct anterior approach (DAA) and the posterior lateral approach (PLA), and to determine their predictive values for the risk of thrombosis.