骨科患者临床重要性静脉血栓栓塞症发生的描述性分析

A descriptive analysis on clinically important venous thromboembolism in orthopedic patients

[目的]探讨骨科不同疾病的临床重要性静脉血栓栓塞症(clinically important venous thromboembolism,CIVTE)分布情况及解剖分布特点。[方法]对本院介入科2014年1月~2017年2月收治的经双下肢多普勒超声或静脉造影证实发生CIVTE的159例骨科患者进行回顾性分析,记录年龄、性别、骨科疾病诊断、存在的合并症、血栓发生部位、血栓类型、肺栓塞并发情况等,对所有数据汇总,按照不同骨科疾病进行分类,比较不同疾病所占比例及血栓类型分布差异。[结果]159例介入科收治确诊CIVTE的骨科患者中,四肢(包括骨盆、髋臼)骨折占44.65%(71/159),脊柱疾病占20.13%(32/159),关节置换占15.72%(25/159),小外伤、清创占10.06%(16/159),关节镜手术占7.55%(12/159),其他占1.89%(3/159)。四肢骨折中髋周骨折最多见,脊柱疾病中腰椎退行性疾病最多见。女性平均年龄比男性高10.80岁,两者比较差异有统计学意义(t=-4.899,P<0.001)。发病高峰为40~69岁,男性发病高峰为40~49岁,女性为60~69岁。混合型血栓最常见,占42.14%。血栓形成易累及左下肢。住院期间的病死率为1.26%。[结论]不同骨科疾病CIVTE所占比例及解剖分布不同,四肢骨折所占比例最高,混合型血栓最多见。女性平均发病年龄高于男性,左下肢血栓形成高于右下肢。

[Objective] To describe the clinical characteristic and anatomical distribution of clinically important venous thromboembolism（CIVTE） in orthopedic patients. [Methods] From January 2014 to February 2017, 159 orthopedics patients with CIVTE confirmed by bilateral Doppler ultrasonography or venography in our hospital were retrospectively analyzed. The age, gender, clinical diagnosis, complications, the anatomical distribution, type of thromboembolism and whether or not accompanied with pulmonary embolism were recorded. All the data were summarized to describe the constitution of different disease and anatomical distribution. [Results] Among the 159 orthopedic patients with CIVTE, 71 patients（44.65%） were diagnosed of fractures in extremities, including pelvic and acetabular fractures, 32（20.13%） of spinal diseases, 25（15.72%） of hip and knee arthroplasty, 16（10.06%） of traumatic debridement, 12（7.55%） of arthroscopy and 3（1.89%） of other diseases. The most common fractures were hip fractures, while the most common spinal diseases were lumbar degeneration disease. Regarding to the gender difference, the female was 10.80 years older than men as thromboembolism happened（P=0.000）. The peak of incidence was found from 40 to 69 years on average, whereas 40 to 49 years in male, and 60 to 69 in male respectively. The mixed type ofthrombosis accounted for 42.14%. The left lower extremity was more frequently involved than the right side. The mortality during hospitalization was 1.26%. [Conclusion] The CIVTE in orthopedics patients, The most common orthopedics diseases were extremities fractures, and the most common thrombosis was mixed type. The average age of women was higher than men, and the left lower extremity was more frequently involved.