创伤骨折并发下肢深静脉血栓的危险因素分析

Risk factor analysis of traumatic fractures combined with lower limb deep vein thrombosis

目的 探讨创伤骨折患者并发下肢深静脉血栓（DVT）的危险因素,为DVT的预防提供参考.方法 以1 068例创伤骨折患者为研究对象,对与DVT发生可能相关的涉及患者一般情况、受伤类型、骨折情况及手术情况4个方面的因素进行单因素分析,并筛选差异有统计学意义的危险因素进行多因素相关分析.结果 1 068例创伤骨折患者中DVT总发生率为12.0%.单因素分析发现患者一般情况包括男性、年龄＞60岁、身体质量指数BMI≥25 kg/m2、有吸烟史、缺乏锻炼患者DVT的发生率较高;既往有糖尿病、高血压、冠心病、脑血管病患者DVT的发生率亦高于总体水平.不同受伤类型中坠落伤DVT的发生率最高,达45.6%.不同部位骨折DVT的发生率不同,其中股骨干骨折最高,达20.5%.3处以上骨折DVT的发生率为51.7%,2处为14.2%,而单处骨折仅为3.7%.粉碎性骨折DVT发生率显著高于总体水平.DVT发生率随手术持续时间延长呈逐渐升高趋势,术中大量输血或硬膜外麻醉患者DVT的发生率显著增高.多因素分析发现9个DVT的独立危险因素,并且危险因素数量越多,DVT发生率越高.结论 年龄＞60岁、BMI≥25 kg/m2、有吸烟史、坠落伤、3处以上骨折、粉碎性骨折、骨折后休克、手术持续时间＞2 h、接受硬膜外麻醉是创伤骨折患者DVT发生的危险因素.

Objective To explore the risk factors of lower limb deep vein thrombosis （DVT） in patients with traumatic fractures so as to provide references for prevention of DVT. Methods A total of 1 068 patients with traumatic fractures were involved in the study to analyze the incidence of DVT under 43 risk factors including general state, injury type, fracture condition and operation and screen significant factors for multiple factor analysis. Results The total incidence rate of DVT in 1 068 patients was 12.0%. The univariate analysis showed that male patients at age 〉60 years, with BMI≥25 kg/m2, history of smoking, lack of exercises, history of diabetes, hypertension, coronary artery disease and cerebrovascular disease had higher incidence rate of DVT. In different injury types, the fall injury caused the highest incidence rate of DVT （45.6%）. There were different DVT rates for different fracture position,with the highest incidence rate of DVT for femur shaft fracture （20.5%）. The incidence rate of DVT was 51.7% for fractures of more than three parts, 14.2% for fractures of two parts and only 3.7% for sole part. The incidence rate of DVT for comminuted fractures was higher than the overall rate. The operation duration, massive transfusion during operation and epidural anesthesia were related with the increase of incidence of DVT. Multivariate analysis found nine independent risk factors and showed that the more risk factors were, the higher incidence of DVT was. Conclusions The risk factors of DVT for traumatic fractures include age 〉60 years, BMI≥25 kg/m2, history of smoking, fall injury, more than three parts of fractures, comminuted fractures, operation duration 〉 2 hours, massive transfusion during operation and epidural anesthesia.