1.The First Affiliated Hospital of Soochow University;2.苏州大学附属第一医院
［目的］ 探究初次全膝关节置换术后下肢深静脉血栓形成的解剖分布特点，并进一步探究血凝、血脂代谢指标对血栓分布的影响近端静脉血栓形成的危险因素。［方法］ 按照纳入与排除标准，回顾性分析2016年01月至-2018年12月收治期间于本院的97例行初次全膝关节置换术，且术后经多普勒超声诊断为深静脉血栓的97例患者的病例临床资料，。按照术后血栓累及部位分组，其中为远端DVT组型82例，近端DVT组型15例。观察并比较两组患者血栓形成的部位，并采用单因素及多因素逻辑回归分析进一步探究近端下肢深静脉血栓发生的相关因素。并进一步比较两组患者术前血凝及血脂代谢指标的差异。［结果］全膝关节置换术后血栓最常累及肌间静脉、胫后静脉、腓静脉及腘静脉。远端型中孤立型血栓发生率高于非孤立型（60 vs 22，73.17% vs 26.83%）而近端型中非孤立性血栓发生率高于孤立性（9 vs 6，60.00% vs 40.00%）。单因素比较表明：近端型患者手术时间显著高于远端型患者（P＜0.05），麻醉持续时间显著高于远端型患者（P＜0.05），远端型患者术前具有静脉曲张史比率显著高于远端型患者（P＜0.05）。多因素逻辑回顾表明：手术时间延长（OR=1.111, 95%CI＝1.011-1.220，P=0.028）、xx（OR=x.xxx, P=x.xxx）、xx（OR=x.xxx, P=x.xxx）、xx（OR=x.xxx, P=x.xxx）是全膝关节置术后发生近端下肢深静脉血栓的危险因素。［结论］全膝关节置换术后血栓以肌间静脉血栓最为常见，近端血栓多为非孤立型而远端血栓多为孤立型。此外，术前甘油三酯水平升高可能与全膝关节置换术后远端深静脉手术时间延长是近端血栓血栓形成的危险因素相关。
[Objective] To explore the anatomical distribution characteristics of thrombosis after primary total knee arthroplasty, and to further explore the risk factors of proximal deep venous thrombosis. [Method] According to the inclusion and exclusion criteria, the clinical data of 97 patients admitted to our hospital from January 2016 to December 2018 were retrospectively analyzed. According to the site of postoperative thrombosis, there were 82 cases of distal type and 15 cases of proximal type. The sites of thrombosis were observed and compared between the two groups, and univariate and multivariate logistic regression analysis was used to further explore the related factors of proximal lower limb deep vein thrombosis. [Results] The most common thrombosis after total knee replacement involved the muscular vein, posterior tibial vein, fibular vein and popliteal vein. The incidence of isolated thrombus was higher in the distal type than in the non-isolated type (60 vs 22, 73.17% vs 26.83%), while the incidence of non-isolated thrombus was higher in the proximal type than in the isolated type (9 vs 6, 60% vs 40%). Univariate comparison showed that the operative time and duration of anesthesia in patients with proximal type were significantly higher than those with distal type (P < 0.05), and the ratio of preoperative varicose vein history was significantly higher than that in patients with distal type (P < 0.05). Multivariate logistic review showed that prolonged operative time (OR=1.111, 95%CI = 1.011-1.220, P=0.028) was a risk factor for proximal deep vein thrombosis after total knee arthroplasty. [Conclusion] Intermuscular vein thrombosis was the most common type of thrombosis after total knee replacement. Proximal thrombus was mostly non-isolated and distal thrombus was mostly isolated. In addition, prolonged operative time is a risk factor for proximal deep venous thrombosis.