摘要
目的探讨下肢闭合骨折24 h内下肢深静脉血栓形成(DVT)的发生率及危险因素。方法回顾性分析2014年10月至2018年3月西安市红会医院创伤骨科收治的下肢闭合骨折后24 h内入院患者的病例资料,依据纳入及排除标准共685例患者参加研究。其中男314例,女371例,年龄(59.83±19.93)岁;股骨粗隆间骨折184例,股骨粗隆下骨折11例,股骨颈骨折171例,股骨干骨折35例,膝关节周围骨折129例,胫腓骨干骨折61例,踝关节骨折74例,足部骨折20例。根据患者入院时双下肢静脉彩色多普勒超声结果分为血栓组和无血栓组。对患者的年龄、性别、骨折部位、术前美国麻醉医师协会(ASA)分级、入院时的实验室检查、是否合并内科疾病等可能的危险因素进行单因素分析,再采用多因素Logistic回归分析确定其独立危险因素。结果685例下肢闭合骨折患者中发生下肢DVT者144例,发生率21.02%,其中近端血栓与混合血栓的总发生率为2.34%。单因素分析显示性别、年龄、骨折部位、术前ASA分级、入院时血红蛋白和红细胞压积水平会对下肢DVT形成产生影响。多因素Logistic回归分析结果显示,年龄≥45岁、骨折部位是下肢骨折24 h内发生下肢DVT的独立危险因素。结论下肢闭合骨折后24 h内就会发生下肢DVT。患者的年龄、骨折部位为下肢闭合骨折后24 h内发生下肢DVT的独立危险因素。下肢骨折患者应及时就医,入院后尽早进行DVT预防和诊治,防止致死性肺栓塞发生。
Objective To investigate the incidence and risk factors of deep vein thrombosis(DVT)in lower limbs within 24 hours after closed fracture of lower extremities.Methods A retrospective analysis of 685 patients admitted to the hospital within 24 hours after closed fractures of the lower extremities from October 2014 to March 2018 in Xi’an Honghui Hospital were retrospectively reviewed and included for analysis according to the inclusion and exclusion criteria.There were 314 males and 371 females,with an average age of 59.83±19.93 years old.There were 184 cases of femoral intertrochanteric fractures,11 cases of femoral subtrochanteric fractures,171 cases of femoral neck fractures,35 cases of femoral shaft fractures,129 cases of peri-knee fractures,61 cases of tibiofibular shaft fractures,74 cases of ankle fractures and 20 cases of foot fractures.According to the results of color Doppler ultrasonography of lower extremity veins at admission,the patients were divided into two groups:thrombus group and non-thrombus group.Potential risk factors including age,sex,fracture type,ASA classification,laboratory examination at admission,and medical complications were analyzed by univariate analysis.Multivariate logistic regression analysis was performed to determine the independent risk factors.Results Among the 685 patients suffering lower extremity fractures,144 had lower extremity DVT,accounting for 21.02%.The incidence of proximal thrombus and mixed thrombus was 2.34%.Univariate analysis showed gender,age,fracture site,ASA grade,hemoglobin at admission,and hematocrit at admission had an effect on DVT in the lower extremities.Multivariate logistic regression analysis showed that age of 45 years or older and fracture site were independent risk factors for DVT in lower extremity within 24 hours.Conclusion The lower extremity DVT occurs within 24 hours after closed fractures of the lower extremities.The age of 45 years or older and fracture site are independent risk factors for DVT in lower extremity within 24 hours after the lower extremity closed fracture.Patients suffering lower extremity fractures should seek medical advice promptly.Prevention and treatment of DVT should be carried out as soon as possible after admission to prevent the occurrence of fatal pulmonary embolism.
作者
李树灏
张堃
衡立松
冯东旭
蔡枭
田丁
杨娜
王鹏飞
朱养均
LI Shuhao;ZHANG Kun;HENG Lisong;FENG Dongxu;CAI Xiao;TIAN Ding;YANG Na;WANG Pengfei;ZHU Yangjun(Xi’an Medical University,Xi’an 710068,China;Department of Orthopaedic Trauma,Honghui Hospital Affiliated to Xi’an Jiaotong University,Xi’an 710054,China)
出处
《国际骨科学杂志》
2019年第5期306-310,共5页
International Journal of Orthopaedics
基金
陕西省重点研发计划(2017ZDXM-SF-009)
关键词
下肢
骨折
静脉血栓形成
发病率
危险因素
Lower extremities
Fractures
Venous thrombosis
Incidence
Risk factors
