骨质疏松性骨伤患者术前下肢深静脉血栓筛查及影响因素分析

Screening on Deep Venous Thrombosis of Lower Extremities in Patients with Osteoporotic Bone Injury and Its Influencing Factors

目的探讨影响骨质疏松性骨伤患者术前下肢深静脉血栓发生的相关因素.方法选取690例骨质疏松性骨伤患者,入院后24 h内行双下肢静脉超声筛查和D-二聚体浓度检测,并采取常规血栓防治流程;收集患者年龄、性别、骨折部位、合并内科基础疾病情况,分析与下肢深静脉血栓发生的相关性.结果股骨颈骨折患者中术前出现下肢深静脉血栓41例(13.85%),明显低于股骨转子间骨折患者(75例,19.04%),差异具有统计学意义(P<0.05);男性患者下肢深静脉血栓发生率明显高于女性患者,差异具有统计学意义(P<0.05);不同年龄段患者术前下肢深静脉血栓发生率之间差异无统计学意义(P>0.05).骨折后24 h内下肢深静脉血栓发病率较高,19例(46.34%)股骨颈骨折患者出现下肢深静脉血栓,39例(52.00%)股骨转子间骨折患者出现下肢深静脉血栓,之后下肢深静脉血栓发病率明显降低.骨折后24 h内D-二聚体浓度>300 ng/m L的患者下肢深静脉血栓发生率均明显高于≤300 ng/m L的患者,差异具有统计学意义(P<0.05).股骨颈骨折患者中术前合并低蛋白血症、贫血的患者下肢深静脉血栓发生率明显高于未合并者,差异具有统计学意义(P<0.05);股骨转子间骨折患者中术前合并心律失常、电解质紊乱、低蛋白血症、贫血的患者下肢深静脉血栓发生率明显高于未合并者,差异具有统计学意义(P<0.05).结论骨质疏松性骨伤患者术前下肢深静脉血栓发生率较高,应从急症诊断开始给予预防措施,避免危险因素,以降低术前下肢深静脉血栓发生率.

Objective To analyze the related factors of deep venous thrombosis of lower extremities in patients with osteoporotic bone injury. Method A total of 690 cases with osteoporotic bone injury were selected. After admission within 24 h,ultrasound screening was performed,D-dimer concentrations in both lower extremities were detected,and routine thrombus control procedure was adopted. Age,gender,fracture location and basic internal medical disease conditions were collected,and the relationship between these information and deep venous thrombosis was analyzed. Results Femoral neck fracture in patients with preoperative lower extremity deep vein thrombosis of 41 cases（ 13. 85%）,was significantly lower than that of 75 cases of intertrochanteric fracture patients（ 19. 04%）（ P0. 05）. Male patients with lower extremity deep vein thrombosis was significantly higher than that of female patients,and the difference was statistically significant（ P 〈0. 05）. The incidence of deepvenous thrombosis in different age groups was not statistically significant（ P〈0. 05）. The incidence of deep vein thrombosis of lower extremities was higher in 24 h after fracture. In 19 cases（ 46. 34%） with transcervical fracture,there were deep venous thrombosis in lower extremities. In 39 cases（ 52%） with intertrochanteric fracture,there were deep venous thrombosis in lower extremities,and then the incidence of deep vein thrombosis decreased significantly. After fracture within 24 h,the incidence rate of deep venous thrombosis in the patients with D-dimer concentration more than 300 ng/m L was significantly higher than the patients with D-dimer concentration less than 300 ng/m L（ P 〈0. 05）. In the patients with transcervical fracture,the incidence rate of deep venous thrombosis in the patients with the complications of hypoproteinemia and anemia before operation was much higher than those without complication（ P 0. 05）. In the patients with intertrochanteric fracture,the incidence rate of deep venous thrombosis in the patients with the complications of arrhythmia,electrolyte disturbances,hypoproteinemia and anemia before operation was much higher than those without complication（ P0. 05）. Conclusion The incidence of deep venous thrombosis in the osteoporotic bone injury patients is relatively high in the nation. We should take preventive measures from the perspective of emergency diagnosis to avoid risk factors and reduce the incidence of deep vein thrombosis before operation.