膝关节多发韧带损伤患者术前深静脉血栓形成的发生率及影响因素

Factors influencing the incidence of preoperative deep venous thrombosis in patients with multiligament knee injuries

目的探讨膝荚节多发韧带损伤患者术前深静脉血栓形成（DVT）的发生率及相关影响因素。方法回顾性分析2007年6月至2010年12月收治的130例膝关节多发韧带损伤患者资料，男102例，女28例；平均年龄为（35．8±3．8）岁，平均体质量指数（BMI）为（24．5±4．3）kg／m2。统计患者术前DVT的发生牢，然后将患者分为血栓组和非血栓组。比较两组患者的性别、年龄、BMI、致伤原因、受伤至检查时间、是否合并下肢骨折、损伤严重程度评分、是否吸烟及相关血液学检查结果（D-二聚体水平、血小板计数、甘油三酯水平、纤维蛋白原水平）等。对P〈0．05的因素再进行多心素logistic凹归分析，以确定其独立危险因素。结果130例患者中12例患者（9．2％）术前发生DVT。，血栓组与非血栓组患者的性别、年龄、BMI、致伤原因、受伤至检查时问、损伤严重程度评分、是否吸烟及甘油蔓酯水平比较差异均无统计学意义（P〉0．05）。而两组患者是否合并下肢骨折、D-二聚体水平、血小板计数及纤维蛋白原水平比较差异均有统计学意义（P〈0．05）。多因素logistic同归分析结果硅示：D。二聚体水平和纤维蛋白原水平升高、合并下肢骨折为DVT的独立危险因素（P〈0．05）。结论膝关节多发韧带损伤患者术前DVT的发生率约为9．2％，D-二聚体水平和纤维蛋白原水平升高、合并下肢骨折足此类患者术前发生DVT的独立危险因素。

Objective To determine the factors influencing the incidence of preoperative deep ve- nous thrombosis （DVT） in patients with multiligament knee injuries. Methods From June 2007 to De- cember 2010, 134 consecutive patients with multiligament knee injuries were admitted to our department. Of them. 130 were included in our study. They were 102 men and 28 women, with an average age of 35.8 ± 3.8 years and an average body mass index （BMI） of 24. 5 ±4. 3 kg/m2. According to the incidence of preoper- ative DVT, they were divided into a DVT group and a non-DVT group. The 2 groups were compared in terms of gender, age, BMI, cause of injury, interval between injury and inspection, combined lower limb fracture, injury severity score（ISS）, smoking and results of hematologic tests （D-dimer, blood platelet count, triglyc- eride and fibrinogen） . Muhifactor logistic regression analysis was conducted of the factors of P 〈 0. 05 to determine the independent risk factors. Results Of the 130 patients, 12 （9.2%） were diagnosed with DVT. The 2 groups were not significantly different regarding gender, age, BMI, cause of injury, interval between injury＇ and inspection, smoking, ISS, or triglyceride level （ P 〉 0.05） . However, there were sig- nificant differences between the 2 groups regarding combined lower limb fracture, D-dimer level, blood platelet cnunt, and fibrinogen level（ P 〈 0. 05）. The logistic regression analysis showed that D-dimer level, increased fibrinogen level, aml complication with lower limb fracture were the independent risk factors of DVT（ P 〈 0. 05）. Conclusions The incidence of preoperative DVT in patients with multiligament knee injuries was about 9.2% in our study. D-dimer level, increased fibrinogen level and complication with lower limb fracture are independent risk factors of preoperative DVT in such patients.