创伤骨折患者术前行血管超声检查及测定D-二聚体的意义

Importance of preoperative ultrasound and D-dimer determination for patients with traumatic fractures

目的 回顾分析创伤骨折患者术前血管彩色多普勒超声检查诊断静脉血栓的价值及测定D-二聚体的意义,探讨D-二聚体与下肢静脉血栓的关系.方法 选择2008年3月-2009年4月因创伤致多发骨折、股骨骨折、胫骨或胫腓骨折当天入院,拟行手术切开复位术的1000例患者,其中男568例,女432例;年龄20～90岁[（54.8±21.50）岁].患者入院第2天清晨抽静脉血测定血清D-二聚体,拟行骨折复位术前1 d（骨折患肢消肿后,约骨折后4～10 d）,行下肢血管彩色多普勒超声检查.结果 1000例患者行下肢血管彩色多普勒超声检查,64例（6.4%）存在下肢深静脉血栓,其中髂-股静脉血栓26例,胭-胫静脉血栓10例,肠腓肌、比目鱼肌血栓28例.骨折后2 d,1000例患者中有736例（73.6%）D-二聚体＞正常值（324μg/L）,伤后4～10 d其中56例（7.6%）发生血栓;骨折后2 d,264例（26.4%）D-二聚体≤324μg/L,伤后4～10 d其中8例（3.0%）患者发生血栓;两组比较,差异有统计学意义（P＜0.01%）.D-二聚体＞650μg/L的患者血栓发生率显著高于D-二聚体＜650μg/L的患者（P＜0.01）.结论 创伤骨折术前行下肢血管彩色多普勒超声检查可降低麻醉手术期深静脉血栓引发致命性肺栓塞的风险.D-二聚体增高,可能引发血栓,但D-二聚体正常后也有发生血栓可能,不可忽视.

Objective To retrospectively analyze the importance of preoperative ultrasound and D-dimer determination for patients with traumatic fractures so as to evaluate the value of vascular color Doppler ultrasound in diagnosing of vein thrombosis and the correlation between D-dimer level and lower extremity vein thrombosis. Methods The study involved 1000 in-patients with multiple traumatic fractures, femoral fractures, tibial fractures or tibiofibular fractures admitted from March 2008 to April 2009 who were prepared for open reduction surgery. There were 568 males and 432 females, at age range of 20-90 years （ average 54.8 years）. Vein D-dimer was examined in the morning on the second day after admission. Vascular color Doppler ultrasound was performed on the lower extremity one day before operation （after the swelling faded away, about 4-10 days after fracture）. Results The vascular color Doppler ultrasound on the lower extremity showed vein thrombosis of the lower extremity in 64 patients （6.4%） including 26 patients with iliac- femoral vein thrombosis, 10 with popliteal-tibial vein thrombosis and 28 with gastrocnemius or soleus muscle vein thrombosis. On the second day after operation, out of 736 patients （73.6%） with D-dimer above normal （324 μg/L）, 56 patients （7.6%） developed thrombosis afterwards;of 264 patients （26.4%） with normal D-dimer, eight patients （3.03%） developed thrombsis. Incidence of thrombosis in patients with D-dimer above 650 μg/L was higher than that in patients with D-dimer below 650 μg/L （P〈0. 01）. Conclusions Preoperative lower extremity vein Doppler ultrasound in traumatic fracture patients can lower the risk of fatal lung thrombosis caused by existing deep vein thrombosis.D-dimer above normal level indicates tendency of thorombosis. However, normal D-dimer still have the possibility to develop thrombosis, which deserves attention.