摘要
目的探讨股骨转子间骨折患者术前和术后下肢深静脉血栓形成(DVT)相关的危险因素。方法采用回顾性病例对照研究分析2015年7月—2017年10月西安交通医学院附属红会医院收治的218例股骨转子间骨折患者临床资料,其中男85例,女133例;年龄32~102岁[(76.0±11.9)岁]。213例接受切开复位内固定术,4例接受半髋关节置换术,1例接受外固定术。所有患者分别于术前和术后进行双下肢深静脉超声判断DVT的发生情况。下肢深静脉血栓分为远端血栓、近端血栓和混合血栓。根据术前和术后超声检查结果,将患者分为血栓组[术前82例(37.6%),术后128例(58.7%)]和非血栓组[术前136例(62.4%),术后90例(41.3%)]。分别记录术前及术后DVT的部位及转归情况。对所有患者进行血栓形成相关危险因素评估,包括患者一般资料、手术时间、止血带时间、输血量、失血量、输液量、引流量及血清学指标。多因素Logistic回归分析危险因素。结果术前DVT发生率为37.6%,术后DVT发生率上升到58.7%,血栓类型以远端DVT为主,分别占术前和术后深静脉血栓的86.6%和90.6%,术后有2.8%的远端DVT延伸至腘静脉以上,23.4%的患者在术前没有血栓形成,而在术后出现远端、近端或混合DVT(分别为22.0%、0.5%和0.9%)。没有发生致命性肺栓塞。单因素分析结果显示,术前血栓组与术前无血栓组在年龄、性别、骨折侧别、合并其他疾病、体重指数、美国麻醉医师协会(ASA)分级、入院D-二聚体和入院C-反应蛋白(CRP)等方面差异无统计学意义(P>0.05),骨折至住院时间和骨折至手术时间两组间差异有统计学意义(P<0.05);术后血栓组与术后无血栓组在年龄、性别、骨折侧别、合并其他疾病发病率、体重指数、住院时间、ASA分级、手术方式、手术时间、输血量、失血量、输液量、引流量、入院时D-二聚体和入院时CRP等方面差异无统计学意义(P>0.05),骨折至入院时间、骨折至手术时间、术前D-二聚体、术后1 d D-二聚体,术后5 d D-二 聚体水平和术后5 d CRP等方面在两组间差异有统计学意义(P<0.05)。多因素分析结果显示,骨折至入院时间(OR=1.137,95%CI 1.002~1.290,P<0.05)和术后1 d D-二聚体(OR=1.087,95%CI 1.033~1.142,P<0.05)与术后DVT显著相关。结论对于股骨转子间骨折患者,血栓类型以远端DVT为主,骨折至住院时间是术前和术后DVT形成的独立危险因素,骨折至手术时间是术前DVT发生的独立危险因素。早期干预(早期入院和早期手术)可能会降低DVT的发生率。
Objective To investigate the incidence of pre-and post-operative lower extremity deep venous thrombosis(DVT)in hospitalized patients with intertrochanteric fractures and to analyze the relevant risk factors.Methods A retrospective case control study was conducted to analyze the data of 218 patients with femoral intertrochanteric fractures admitted to Xi'an Honghui Hospital,Xi'an Jiaotong University from July 2015 to October 2017,including 85 males and 133 females.There were 85 males and 133 females,aged 32-102 years[(76.0±11.9)years].Of the patients,213 had open reduction and internal fixation,4 partial hip arthroplasty,and 1 external fixation.All patients underwent deep venous ultrasound of the lower extremities before and after surgery to determine the occurrence of DVT.DVT of the lower extremities was divided into distal thrombosis,proximal thrombosis and mixed thrombosis.According to the preoperative and postoperative ultrasonography results,the patients were divided into thrombosis group[82 patients(37.6%)before operation,128 patients(58.7%)after operation]and non thrombosis group[136 patients(62.4%)before operation,90 patients(41.3%)after operation].Location of DVT were recorded before and after operation and outcome was evaluated.All patients were assessed for risk factors associated with thrombosis,including general patient data,time of surgery,tourniquet time,blood transfusion,blood loss,fluid volume,drainage,and serological markers.Multivariate Logistic regression analysis was used for detecting the risk factors.Results The DVT rate was 37.6% preoperatively and increased to 58.7% postoperatively.The type of thrombosis was mainly distal DVT,which accounted for 86.6%and 90.6% of DVT before and after surgery,respectively.After the operation,2.8% of the distal DVT extended above the popliteal vein.A total of 23.4% of the patients had no thrombosis before surgery,and distal,proximal,or mixed DVT occurred after surgery(22.0%,0.5%and 0.9%,respectively).No fatal pulmonary embolism occurred.The univariate analysis showed no statistical differences between the preoperative thrombosis group and non thrombosis group in terms of age,gender,fracture side,combined diseases,body mass index,American Society of Anesthesiologists(ASA)classification,admission D-dimer,and admission C-reactive protein(CRP)(P>0.05),but the time from fracture to hospitalization and the time from fracture to surgery were significantly different between the two groups(P<0.05).There were no statistical differences between the postoperative thrombosis group and the postoperative non-thrombosis group in age,gender,fracture side,combined diseases,body mass index,length of stay,ASA classification,surgical method,operation time,blood transfusion,blood loss,infusion volume,drainage volume,D-dimer on admission,and CRP on admission(P>0.05),but the time from fracture to admission,time from fracture to surgery,D-dimer before surgery,D-dimer at day 1 after surgery,D-dimer at day 5 after surgery,and CRP at day 5 after surgery showed significant differences between the two groups(P<0.05).Multivariate analysis results showed the time from fracture to hospitalization(OR=1.109,95%CI 1.003-1.225,P<0.05)and the time from fracture to surgery(OR=1.090,95%CI 1.007-1.180,P<0.05)were independent risk factors for preoperative DVT.The time from fracture to hospital(OR=1.137,95%CI 1.002-1.290,P<0.05)and 1 day postoperative D-dimer(OR=1.087,95%CI 1.033-1.142,P<0.05)were independent risk factors for postoperative DVT.Conclusions For intertrochanteric fractures,distal DVT is the main type of thrombosis.Time from fracture to hospitalization is an independent risk factor of DVT before and after operation,and time from fracture to operation is an independent risk factor of DVT before operation.Early intervention(early admission and early surgery)may reduce the incidence of DVT.
作者
费晨
王鹏飞
张斌飞
魏巍
屈霜威
杨琨
李智
庄岩
张堃
Fei Chen;Wang Pengfei;Zhang Binfei;Wei Wei;Qu Shuangwei;Yang Kun;Li Zhi;Zhuang Yan;Zhang Kun(Department of Orthopedic Trauma,Honghui Hospital,Xi'an Jiaotong University College of Medicine Xi'an 710054,China;Postgraduate Department of Xi'an Medical University,Xi'an 710068,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2020年第3期251-258,共8页
Chinese Journal of Trauma
基金
陕西省自然科学基金(2017ZDXM-SF-009)。
关键词
股骨骨折
静脉血栓形成
超声检查
Femoral fractures
Vein thrombosis
Ultrasonography
