股骨颈骨折术后发生下肢深静脉血栓的相关研究

Study of deep venous thrombosis in lower extremities after femoral neck fracture

目的探讨股骨颈骨折术后形成下肢深静脉血栓（DVT）的原因。方法回顾性分析西安交通大学医学院附属红会医院创伤骨科2014年9月-2017年12月收治的483例股骨颈骨折患者的临床资料，根据B超检查结果的不同，将患者分为血栓组（n=149）与非血栓组（n=334），记录患者并发症、输血量、复位方式、内固定、手术时间、术中失血量以及术后血栓发生情况。计数资料采用百分比（％）表示，组间比较采用∥检验；计量资料以（x±s）表示，组间比较采用独立样本t检验。计算股骨颈骨折患者术后DVT的发病率。结果483例患者中，术后发生DVT149例，发病率为30．8％；复位方式、内固定方式、术中失血量均会影响股骨颈骨折术后DVT的发生，P〈0．05。其中复位方式中，切开复位367例，33．2％（122／367）发生DVT；闭合复位116例，23．3％（27／116）发生DVT，切开复位DVT发病率高于闭合复位。内固定方式中，以全髋关节置换及髓内钉固定术后DVT发病率最高，分别为52．8％、50．0％；血栓组术中失血量（246．9±178．1）ml高于非血栓组（206．3±126．7）ml。结论股骨颈骨折术后DVT发病率较高，其中复位方式、内固定方式、术中失血量均会影响股骨颈骨折术后DVT的发生。股骨颈骨折术后患者DVT影响因素众多，需要全面评估术后患者发牛DVT的危盼性。

Objective To explore the causes of deep venous thrombosis of the lower extremities after femoral neck fracture. Methods To retrospectively analyze the clinical data of 483 cases of femoral neck fractures treated from September 2014 to December 2017 from Department of Traumatic Orthopedics, Xi＇ an Jiaotong University School of Medicine Affiliated Honghui Hospital. Please record the patient＇s complications, blood transfusion volume, reduction method, internal fixation, operative time, intraoperative blood loss, and postoperative thrombosis. Count data were expressed as percentage （%） and analyzed by X2 test between the two groups; measurement data were expressed as （ x±s） , and two independent samples was used by t test. To calculate the incidence of postoperative deep venous thrombosis in patients with femoral neck fractures and to investigate the causes of deep vein thrombosis of the lower extremities after femoral neck fractures. Results Of the 483 patients, 149 cases of deep vein thrombosis of the lower extremities occurred after surgery, with an incidence of 30.8%. The reduction method, internal fixation, and intraoperative blood loss all affected the occurrence of deep venous thrombosis after femoral neck fracture （ P 〈 0.05 ）. Among the reset methods, 367 cases were open and closed, 33.2% （122/367） had deep venous thrombosis, closed reduction was 116 cases, and 23.3% （27/116） had deep venous thrombosis. The incidence of open reduction deep venous thrombosiswas higher than closed reduction; among the internal fixation methods,fixation, the incidence of deep venous thrombosis after total hip arthroplasty and intramedullary nailing was the highest, which was 52.8% and 50.0% , respectively. The hemorrhage volume in the thrombosis group （246.9 ± 178.1 ） ml was higher than that in the non-thrombosis group（206.3 ±126.7） ml. Conclusions The incidence of deep venous thrombosis after femoral neck fractures is high, and the way of reduction, internal fixation, bedtime before operation, and blood loss during operation can affect the occurrence of deep venous thrombosis after femoral neck fracture. There are many factors affecting deep venous thrombosis after femoral neck fracture. It is necessary to fully evaluate the risk of deep venous thrombosis after operation.