老年髋部骨折患者术前下肢深静脉血栓形成的危险因素分析

Risk Factors for Preoperative Lower Extremity Deep Vein Thrombosis in Senile Patients with Hip Fracture

目的研究老年髋部骨折患者术前发生下肢深静脉血栓形成(DVT)的危险因素。方法回顾性分析2015年5月至2016年4月北京积水潭医院创伤骨科和老年科共管模式收治的392例老年髋部骨折患者的临床资料。根据术前静脉造影结果,分析术前下肢DVT的发生率。将术前是否发生下肢DVT的患者进行对比分析,应用单因素分析和多因素Logistic回归,以确定术前发生下肢DVT的危险因素。结果老年髋部骨折术前下肢DVT发生率为11. 0%(43/392)。经单因素对比分析发现DVT组患者造影检查距受伤的时间较无DVT组长,糖尿病、老年痴呆、粗隆部骨折发生率和既往脑血管病患病率较无DVT组高(P <0. 10)。经Logistic回归调整后,股骨粗隆部骨折(OR=2. 30,95%CI 1. 14～4. 64)及造影检查距受伤时间(OR=1. 15,95%CI 1. 03～1. 27)是发生下肢DVT的危险因素(P <0. 05)。结论老年髋部骨折患者术前下肢DVT发生率较高。股骨粗隆部骨折及受伤后等待时间长的患者需要关注是否存在术前下肢DVT。实验室检查不能帮助判断是否发生下肢DVT。

Objective To explore the preoperative risk factors for lower extremity deep vein thrombosis(DVT)in elderly patients with hip fracture.Methods The data of392patients with hip fracture under co-management by Department of Orthopedic Trauma and Department of Geriatrics of Beijing Jishuitan Hospital between May2015and Apr.2016,were retrospectively analyzed.Lower extremity DVT was diagnosed by venography before surgery.The risk factors of preoperative DVT in lower extremities were determined by single factor analysis and multivariate Logistic regression.Results The pre-valence of preoperative lower extremity DVT was11.0%(43/392).The single factor analysis showed that the interval between the examination and the injury in the preoperative DVT group was longer than those in the non-DVT group,and the incidence of diabetes mellitus,senile dementia,trochanter fracture and cerebrovascular disease of the preoperative DVT group were higher than those of the non-DVT group(P<0.10).Furthermore,multiple Logistic regression demonstrated that peritrochanteric fracture(OR=2.30,95%CI1.14-4.64)and elapsed time from injury to venography(OR=1.15,95%CI1.03-1.27)lower extremity were risk factors for preoperative lower extremity DVT(P<0.05).Conclusion Our findings show a high prevalence of preoperative lower extremity DVT in senile patients with hip fracture.Patients with peritrochanteric fracture and delayed venography should be concerned about lower extremity DVT.Laboratory tests cannot help determine whether lower extremity DVT occurs.