股骨头坏死患者外侧入路初次全髋关节置换术后深静脉血栓形成的危险因素分析

Analysis of risk factors for deep vein thrombosis after primary total hip arthroplasty via lateral approach in patients with osteonecrosis of the femoral head

摘要:

目的 分析股骨头坏死患者外侧入路初次全髋关节置换术后深静脉血栓形成的危险因素。方法 回顾性分析2020年9月—2023年2月在西安国际医学中心医院进行外侧入路初次全髋关节置换术的117例股骨头坏死患者的临床资料。根据术后随访深静脉血栓形成情况将患者分为有深静脉血栓组48例和无深静脉血栓组69例。比较两组患者的临床资料；采用多因素一般Logistic回归分析深静脉血栓形成的危险因素；构建风险预测模型，绘制受试者工作特征（ROC）曲线评估模型的准确性，使用Bootstrap方法进行1 000次重复采样验证模型的效能。结果 有深静脉血栓组年龄≥ 65岁占比、有血栓史占比、局部麻醉占比、甘油三酯≥1.7 mmol/L占比和胆固醇≥ 4 mmol/L占比高于无深静脉血栓组（P <0.05）。多因素一般Logistic回归分析结果显示：年龄≥ 65岁［O^R =4.345（95% CI：1.341，14.077）］、有血栓史［O^R =3.541（95% CI：1.210，10.358）］、麻醉方式［O^R =3.438（95% CI：1.147，10.303）］、甘油三酯≥ 1.7 mmol/L［O^R =11.176（95% CI：3.656，34.162）］和胆固醇≥ 4 mmol/L［O^R =6.909（95% CI：2.207，21.631）］均为深静脉血栓的危险因素（P <0.05）。列线图模型预测深静脉血栓的敏感性为87.50%（95% CI：0.748，0.953），特异性为79.7%（95% CI：0.683，0.884），具有良好的拟合校准曲线（P >0.05）。结论 年龄、性别、血栓史、麻醉方式、甘油三酯和胆固醇均为股骨头坏死患者外侧入路初次全髋关节置换术后深静脉血栓形成的危险因素，构建的风险预测模型具有一定的准确性和可行性，对深静脉血栓风险评估具有重要的临床应用价值。

Abstract:

Objective To analyze the risk factors for deep vein thrombosis (DVT) after primary total hip arthroplasty (THA) via a lateral approach in patients with osteonecrosis of the femoral head (ONFH).Methods Clinical data of 117 ONFH patients who underwent primary THA via lateral approach at Xi'an International Medical Center Hospital from September 2020 to February 2023 were retrospectively analyzed. Based on postoperative DVT occurrence, patients were divided into a DVT group (n =48) and a non-DVT group (n =69). Clinical characteristics were compared between groups. Multivariate logistic regression analysis was performed to identify DVT risk factors. A risk prediction model was constructed, and its accuracy was evaluated using receiver operating characteristic (ROC) curves. Model validation was conducted via the Bootstrap resampling method with 1,000 repetitions.Results The DVT group had significantly higher proportions of patients aged ≥ 65 years (P < 0.05), history of thrombosis (P < 0.05), use of local anesthesia (P < 0.05), triglycerides ≥ 1.7 mmol/L (P < 0.05), and cholesterol ≥ 4 mmol/L (P < 0.05) compared to the non-DVT group. Multivariate analysis identified independent risk factors: age ≥ 65 years [O^R = 4.345 (95% CI: 1.341, 14.077) ], history of thrombosis [O^R = 3.541 (95% CI: 1.210, 10.358) ], anesthesia type [O^R = 3.438 (95% CI: 1.147, 10.303) ], triglycerides ≥ 1.7 mmol/L [O^R = 11.176 (95% CI: 3.656, 34.162) ], and cholesterol ≥ 4 mmol/L [O^R = 6.909 (95% CI: 2.207, 21.631) ] (all P < 0.05). The nomogram model demonstrated a sensitivity of 87.50% (95% CI: 0.748, 0.953), specificity of 79.7% (95% CI: 0.683, 0.884), and good calibration (P > 0.05).Conclusion Age, history of thrombosis, anesthesia type, triglycerides, and cholesterol are critical risk factors for DVT after lateral approach THA in ONFH patients. The established prediction model shows clinical utility for risk stratification.