骨科创伤患者深静脉血栓危险因素的研究

Deep vein thrombosis risk in orthopaedic traumatic patients

目的研究骨科创伤患者深静脉血栓（deep vein thrombosis，DVT）的发生率，探讨骨科创伤患者DVT发生的危险因素。方法以2003年11月至2004年10月天津医院收治的新鲜四肢及骨盆骨折患者为研究对象，通过对不同年龄组患者的骨折类型、受伤机制、肿胀程度、既往DVT病史、手术及治疗方法等资料进行统计，并以3次彩色超声多普勒检查为诊断依据。需要手术的患者入院24h内进行第1次静脉多普勒检查，第2次和第3次检查分别在术前2d及术后7d；非手术患者3次检查分别在入院后24h、第5及14天。将需要分析的数据输入临床报告系统数据库1．1版，进行统计学分析及DVT发生率的流行病学分析。结果统计的547例患者中，平均年龄为39．6岁，DVT发生率为12.4％。以股骨干骨折DVT发生率为最高达30．6％，其次为髋部骨折15．7％，膝关节周围骨折14．5％，胫腓骨骨折10.8％。3个部位以上的多部位骨折患者DVT发生率为50％，单部位骨折患者DVT的发生率低于10％。超过半数的DVT（56．7％）发生于受伤3d之内。随着年龄增加DVT发生的风险也随之增大，年龄超过60岁患者的发病风险为184％。吸烟患者发生DVT的危险几乎是非吸烟患者的2倍。结论DVT在骨科创伤患者中具有一定的发生率，其年龄、病史、骨折部位、多发骨折及受伤距手术时间等均与DVT发生相关，须引起骨科临床医生的足够重视，并采取预防措施以降低肺栓塞的发生。

Objective To investigate the incidence rate of deep vein thrombosis （DVT） in orthopaedic trauma patients and to identify DVT risk factors. Methods Patients with fresh four extremities and pelvic fracture between November 2003 and October 2004 were involved in this study and the data was collected prospectively to analyse the age, type of fracture, mechanism of injury, swelling status, history of DVT, operation and treatment details. Each patient had three Doppler ultrasound examinations as the epi- demiology diagnostic criterion for DVT. For the patients requiring surgery, venous duplex ultrasound was performed within 24 hours of admission, followed by another ultrasound within two days before surgery and at the 7th day post-operatively. For the patients requiring conservative management had a venous ultrasound within 24 hours, 5th day and 14th days after admission. Data was entered into a Clinical Reporting System database version 1.1ma specifically programmed for this study and analyzed. Results There were 547 patients, with the mean age of 39.6 years （ranged 28.0-50.0 years）. DVT was found in 68 cases （12.4%）. Most cases occurred with femoral shaft fractures （30.6%）, 15.8% with hip fractures, 14.5% with fractures around the knee and 10.8% with fractured tibia and fibula. The incidence rate of DVT increased to 50% in the patients with multiple fracture, and was less than 10% in the patients with single fracture. Over half of DVT （56.7%） developed within three days after injury. DVT incidence rates increased with age, and up 18.4% in the patients more than 60 years of age. DVT incidence rate in smoking patients was almost twice compared to non smokers. Conclusion The incidence of DVT in orthopaedic trauma patients approaches a considerable level. It has relationships with patient＇s age, history of DVT, fracture site, number of fractures and the time after trauma. The surgeons should recognize the importance to prevent DVT and PE in the traumatic patients.