老年人骨折后早期下肢深静脉血栓形成情况分析

Analysis of deep vein thrombosis of the lower limbs in elder patients at the early stage after fractures

目的探讨老年人骨折后早期下肢深静脉血栓形成情况及血浆D-二聚体对下肢深静脉血栓的预测价值。方法通过对106例老年病人骨折后早期血浆D-二聚体化验及下肢深静脉彩超检查结果,统计得出下肢深静脉血栓的发生率及好发部位。结果 1.老年人骨折第二天下肢深静脉血栓总的发生率为17.0%(18/106),其中下肢骨折血栓发生率26.9%(7/26),骨盆与髋部骨折血栓发生率15.6%(10/64),上肢骨折血栓发生率8.3%(1/12)和脊柱骨折血栓发生率0/4。2.发生下肢深静脉血栓的病例以胫后静脉血栓(11例)和小腿肌间支静脉血栓(9例)最常见,其中4例病人同时发生胫后和肌间支静脉血栓。3.D-二聚体化验值低于500 ug/L的47例老年骨折病人中有6例下肢深静脉发现血栓。结论老年人骨折后早期即可形成深静脉血栓,下肢骨折更是高发人群。血浆D-二聚体化验值低于500 ug/L不能完全排除下肢深静脉血栓的发生。

Objective To investigate the incidence of deep veins thrombosis （DVT） and to evaluate the clinical value of D-dimer test for diagnosing DVT at the early stage after fractures in elder patients. Methods The data of 106 elder patients who had fractures, including results of color Doppler sonography and plasma D-dimer test, were analyzed statistically, The incidence and sites of DVT were calculated. Results 1 ） The total incidence of DVT in elder patients at the 2nd day after fractures was 17.0% （18/106）. The incidences of DVT in lower limb fractures, pelvis and hip fractures, upper limb fractures, and spine fractures were 26.9% （7/26）, 15.6% （10/64）, 8.3% （ 1/12）, and 0. 0% （0/4）, respectively. 2） The peroneal vein thrombosis （11 cases） and crus muscle venous thrombosis （9 cases） were most common in the patients who had DVT. And 4 patients had peroneal vein and crus muscle venous thrombosis simultaneously. 3） Six out of 47 patients whose of plasma D-dimer concentration was lower than 500μg/L had DVT. Conclusion The formation of DVT occurs at the early stage after fractures in elderly patients. Patients with lower llmb fractures are high-risk population. Negative D-dimer test result （ D-dimer 〈 500ug/L） cannot exclude the formation of DVT absolutely.