不同部位骨折深静脉血栓发生率的流行病学研究

Epidemiological study on the incidence of deep vein thrombosis associated with fracture sites

目的探讨不同部位骨折深静脉血栓（deepveinthrombosis，DVT）发生的流行病学特点。方法对天津医院2009年2月至2013年2月所有创伤骨科住院患者发生DVT的病历进行回顾性查阅分析，详细记录每个病历的一般资料、临床诊断、骨折部位、受伤机制、DVT发生时间、合并症等情况，对所有数据汇总，按照不同部位骨折分类，计算DYT总体发生情况及不同部位骨折DVT发生率。结果4年间创伤骨科共收治骨折患者24049例，其中1543例发生DVT，其总体发生率为6．41％（1543／24049）。1543例患者中，713例为下肢骨折，790例为髋周骨折，40例为上肢骨折。髋周骨折总体发生率最高为12．33％（790／6408），下肢骨折总体发生率（6．02％，713／11837）明显高于上肢骨折（0．69％，40／5804）；下肢骨折中股骨远端骨折（股骨髁上、髁间骨折）DVT发生率最高，为23．04％（165／716），股骨干骨折为14．72％（178／1209），髌骨骨折7．27％（110／1513），胫骨平台骨折5．83％（79／1355），胫腓骨骨折2．86％（91／3180），踝关节骨折2．60％（55／2116），跟骨骨折1．17％（15／1281），前足部骨折4．28％（20／467）；上肢骨折中肩部骨折最高，为2．97％（9／303），其余部位骨折均〈1％。结论DVT与骨折部位发生率密切相关，临床应对股骨远端、股骨干、髋周及骨盆骨折进行DVT重点预防。

Objective To retrospectively analyze the incidence of deep vein thrombosis and investigate the epidemiologi- eal characteristics of DVT associated with fracture sites. Methods The clinical records were retrospectively analyzed from Febru- ary 2009 to February 2013 in Tianjin Hospital The general data, clinical diagnosis, fracture site, injury mechanism, DVT occur- rence time and complications were recorded. All the data were summarized, and the overall incidence of DYT and incidence of DVT in different fracture site were calculated according to the different site of the fracture classification. Results 1 543 fractures patients had happened DVT of 24 049 patients during four years. The overall incidence of DVT was 6.41% （1 543/24 049）. In 1 543 DVT patients, there were 713 lower extremity fractures, 790 around hip fractures and 40 upper extremity fractures. The highest overall incidence of DVT was 12.33% （790/6 408） in around hip fractures, the overall incidence of DVT in lower extremity fractures （6.02%, 713/11 837） was obvious higher than upper extremity fractures （0.69%, 40/5804）. In lower extremity fractures, the highest incidence of DVT fracture site was distal of femoral shaft with 23.04% （165/716）, followed by 14.72% （178/1 209） of femoral shaft fractures, patella fracture was 7.27% （110/1 513）, tibial plateau fracture was 5.83% （79/1 355）, tibia and fibula fracture was 2.86% （91/3 180）, ankle fracture was 2.60% （55/2 116）, calcaneus fracture was 1.17% （15/1 281）, forefoot fracture was 4.28% （20/467）. In upper extremity frac- tures, the highest fracture site of incidence of DVT was shoulder fracture with 2.97% （9/303）, other all upper extremity fractures were less than 1%. Conclusion The incidence of DVT is closely related to fracture site, there is significant difference between differ- ent sites of fractures. The fracture site such as distal of femoral shaft, femoral shaft, around of hip joint and pelvic should be been the key sites to prevent for DVT.