老年髋部骨折患者下肢深静脉血栓形成危险因素分析及其转归

Risk factors and prognosis of lower limb deep vein thrombosis after hip fracture among elderly patients

目的观察老年髋部骨折后下肢深静脉血栓发生的特点,分析血栓发生的危险因素。方法 2012年10月—2016年4月在义乌市中心医院骨科治疗的老年髋部骨折患者共60例。其中,股骨颈骨折28例,转子间骨折32例。患者在术前及术后3 d和7 d分别行双下肢静脉彩色多普勒超声血流显像(CDFI)检查,观察下肢深静脉血栓(DVT)形成情况,以年龄、性别、骨折类型、入院至手术时间和骨折至手术时间为变量进行患者术前DVT危险因素分析,以年龄、性别、骨折类型、入院至手术时间、骨折至手术时间、麻醉方法、麻醉时间、手术方法和手术时间为变量进行术后DVT危险因素分析。结果 60例老年髋部骨折患者中,出现下肢DVT 21例(35.0%)。其中9例(15.0%)为术前血栓,12例(20.0%)为术后血栓。86.7%的DVT发生于骨折侧。转子间骨折发生术后DVT的风险是股骨颈骨折的5.977倍(P<0.05)。Logistic回归分析结果显示,骨折类型是老年髋部骨折后下肢深静脉血栓发生的独立危险因素(OR=5.977,P<0.05)。结论老年髋部骨折患者围手术期患肢DVT发生率高于健侧;转子间骨折为术后DVT的危险因素;术前即有较高的DVT发生率,因此入院后应尽早行CDFI检查以便及时发现和处理DVT。

Objective To investigate the clinical characteristics and risk factors of lower limb deep vein thrombosis（ DVT） after hip fracture among elderly patients. Methods Sixty elderly patients suffered from hip fracture in our hospital from October,2012 to April,2016 were recruited. There were 28 cases of femoral neck fracture and 32 cases of intertrochanteric fracture. The color Doppler flow imaging（ CDFI） was used to detect DVT of bilateral lower extremities in all patients before orthopedic surgery and on the 3rdand 7thdays post-operatively. The age,sex,fracture type,hospital-to-operation time and fracture-to-operation time were used to analyze the risk factors of Preoperative DVT. The age,sex,fracture type,hospitalization to operation time,fracture to operation time,anesthesia,Time,surgical method and operation time were used to analysis risk factor of postoperative DVT. The perioperative DVT formation and risk factors were observed and analyzed. Results Among 60 patients,there were 21 cases of DVT（ 35. 0%）. There were 9 patients（ 15. 0%） who developed DVT preoperative and 12 patients（ 20. 0%） after the operation. 86. 7% DVT were found in fracture legs. Logistic regression analysis demonstrated a definite association of intertrochanteric fracture with DVT with odds ratio of 6. 0（ P〈0. 05）. Logistic regression analysis showed that the fracture type was an independent risk factor of deep vein thrombosis in elderly patients with hip fracture（ OR = 5. 977,P〈0. 05）. Conclusion There is higher perioperative DVT incidence on the injured side than the uninjured side. Intertrochanteric fracture is the risk factor for DVT after operation. In addition,the preoperative DVT incidence is relative high which justified early CDFI examination after admission.