上肢创伤骨折术前彩色多普勒超声筛查深静脉血栓的意义

Significance of preoperative color Doppler flow imaging for screening deep vein thrombosis in upper limbs fracture

目的:探讨上肢创伤骨折术前行血管彩色多普勒超声(color Doppler flow imaging,CDFI)筛查上肢深静脉血栓的意义。方法:回顾性分析2009年1月至2011年12月因创伤致上肢桡尺以上骨折入院拟行切开复位术的1200例患者,男833例,女367例;年龄20～87岁,平均(41.94±15.41)岁。所有患者入院时伤肢肿胀、疼痛,入院后立即对伤肢行夹板外固定等治疗。伤肢肿胀好转后3～10d,拟行骨折复位术前1d,行CDFI检查患者上肢静脉血管,了解上肢深静脉血栓发生情况,分析血栓发生与性别、年龄及骨折部位的关系,并对深静脉血栓患者是否合并糖尿病、高血压、高血脂进行回顾性分析。结果:1200例上肢创伤骨折患者术前经CDFI检查,证实并发DVT9例,血栓发生率为0.75%。血栓发生率女性高于男性(P<0.01);30岁以上年龄组有发生血栓的风险;肱骨段以上骨折患者血栓发生率远高于桡尺骨折;9例血栓患者1例合并高血压、高血脂,1例合并糖尿病,7例无高血压、高血脂及糖尿病。结论:上肢创伤骨折有发生深静脉血栓风险,对上肢创伤骨折患者在有条件的医院术前均应行CDFI筛查上肢DVT,对维护医疗安全、降低医疗纠纷及保障患者生命安全有重要意义。

Objective：To explore significance of preoperative color Doppler flow imaging （CDFI） for screening deep vein thrombosis in upper limbs fracture. Methods：From January 2009 to December 2011,1 200 patients with upper limb fracture caused by trauma were respectively analyzed. There were 833 males and 367 females,ranging from 20 to 78 （mean 41.94± 15.41 ） years. All patients had swelling and pain in injured limbs when enrolled. CDFI was used to examine upper limbs vein at 3 to l 0 d after improvement of swelling, 1 day before reduction. Relationship among occurrence of thrombosis, gender, age and fracture sites were analyzed. Patients with DVT were analyzed with respective study to decide whether combined with diabetes, hypertension and hyperlipidemia. Results：All patients were checked by CDFI, which confirmed 9 cases with DVT. The rate of thrombosis was 0.75% ,women than men（P〈0.01 ）.The risk of blood clots occurred over 30 years,and the occurrence of throm- bosis in humerus fracture was higher than radius ulnar fracture. One of 9 patients combined with hypertension and hyperlipi- demia, 1 case combined with diabetes, and 7 cases with no complication. Conclusion： Upper trauma fracture may occur deep vein thrombosis; CDFI should be used to check DVT in qualified hospital, which can maintain medical safety, decrease occur- rence of medical disputes, and ganrantee patient＇s safety.