高龄髋部骨折患者手术前发生DVT的影响因素分析

Analysis of the Influencing Factors of Preoperative Deep Venous Thrombosis of Hip Fracture in Elderly Patients

目的:研究高龄髋部骨折患者在手术前发生下肢深静脉血栓(deep vein thrombosis,DVT)的影响因素。方法:选择高龄髋部骨折患者作为研究对象。在术前24 h内,选用双侧下肢静脉系统多谱勒超声检查、D-二聚体浓度检测明确下肢深静脉血栓发生情况。根据患者病历记录,统计其性别、年龄、骨折部位、骨折后时间以及患者合并的内科疾病情况,并进行相应统计学分析。结果:722例患者被纳入本研究,股骨颈骨折患者312人,股骨转子间骨折的患者410人,股骨转子间骨折患者术前DVT的发生率显著高于股骨颈骨折组,差异具有统计学意义(P=0.014)。股骨颈骨折组中,男性患者术前DVT的发生率显著多于女性患者(P=0.038),贫血患者术前DVT的发生率显著多于无贫血患者(P=0.007),差异有统计学意义;股骨转子骨折组中,电解质紊乱患者术前DVT的发生率显著多于无电解质紊乱患者(P=0.012),差异有统计学意义。手术等待时间延长会导致术前DVT的发病率显著升高。结论:骨折后至术前等待时间的延长、男性患者、股骨转子间骨折、D-dimer浓度升高、贫血以及电解质紊乱会提高术前DVT的发生率。

Objective： To study the risk factors of preoperative deep venous thrombosis （DVT） of hip fracture in elderly patients. Methods： The patients over age 60 with hip fracture were selected as the object of study in 2014. D-dimer test and Doppler ultrasound test were used within 24 hours prior to the operation in order to evaluate the thrombosis of deep venous in bilateral venous system. The patients＇ age, sexes, fractured sites, time before operation and preoperative medical diseases were collected and analyzed statistically to study the risk factors of preoperative deep venous thrombosis. Results： 722 hip fracture in patients were comprised in this retrospective study. 312 patients with femoral neck fracture and 410 patients with intertrochanteric fracture had several kinds of medical diseases, and the number of patients with D-dimer concentration anomaly was 263. The extension of time before operation could increase the incidence of DVT, and the incidence of DVT in patients with intertrochanteric fracture was higher than patients with femoral neck fracture, the difference was statistically significant（P=0.014）. Among the patients with femoral neck fi＇acture, the incidence of DVT in male patients is higher than the female （P=0.038）, and the incidence of DVT in patients with anaemia was also higher than the others （P=0.007）, these differences were statistically significant. In the same time, among the patients with intertrochanteric fracture, those who with electrolyte disorder could have DVT more easily （P=0.012）, the difference was also statistically significant. Conclusions： Prolonging waiting time, male patients, intertrochanteric fracture, high D-dimer level, anaemia and electrolyte disorder can increase the incidence rate of preoperative deep venous thrombosis.