月经期女性下肢骨折术前发生深静脉血栓形成的研究

Preoperative deep venous thrombosis in female patients with lower extremity fracture in menstrual phase

目的 探讨月经期女性下肢骨折术前发生深静脉血栓形成（DVT）的相关因素.方法 回顾性分析2016年10月至2017年10月西安交通大学医学部附属红会医院创伤骨科收治的119例育龄期女性下肢骨折患者资料.根据患者是否进入月经期分为月经组和非月经组.其中月经组41例,年龄（37.1±8.9）岁;非月经组78例,年龄（36.9±8.0）岁.比较两组患者的下肢DVT发生率、D-二聚体、凝血酶原时间、部分凝血酶原时间、凝血酶时间、纤维蛋白原及术前卧床时间.结果 月经期患者下肢DVT发生率（82.9％）高于非月经期（14.1％）,术前卧床时间[（9.1±3.4）d]长于非月经组[（3.8±2.2）d],差异均有统计学意义（P＜0.05）.术前D-二聚体、凝血酶原时间、部分凝血酶原时间、凝血酶时间、纤维蛋白原两组间比较差异均无统计学意义（P＞0.05）.结论 月经期女性下肢骨折术前DVT发生率高,主要原因是术前卧床时间较长.D-二聚体在月经期组筛查血栓形成中意义有限.月经期可能并非手术的禁忌证.

Objective To investigate the factors associated with preoperative deep venous thrombosis （DVT） in female patients with lower extremity fracture in menstrual phase.Methods A retrospective analysis was conducted of the 119 women with lower extremity fracture in childbearing age who had been treated at Traumatic Orthopaedics Center,Red Cross Hospital,Xi＇an Jiaotong University Health Science College from October 2016 to October 2017.Of them,41 were in menstral phase,aged from 20 to 50 years （average,37.1 ± 8.9 years）,and 78 were not,aged from 19 to 50 years （average,36.9 ± 8.0 years）.The 2 groups were compared in terms of DVT incidence,D-dimer level,prothrombin time,partial prothrombin time,thrombin time,fibrinogen level,and preoperative bed time.Results The patients with menstruation had significantly higher incidence of lower extremity DVT （82.9%） and significantly longer preoperative bed time （9.1 ± 3.4 d） than those without menstruation did （14.1% and 3.8 ± 2.2 d,respectively） （P 〈0.05）.There were no significant differences between the 2 groups in the preoperative coagulation indexes：D-dimer,prothrombin time,partial prothrombin time,thrombin time or fibrinogen （P 〉 0.05）.Conclusions The incidence of preoperative DVT may be high the female patients with lower extremity fracture in menstrual phase,chiefly because of long preoperative bed time.Detection of D-dimer level is of limited significance in the screening for thrombosis in menstrual phase.Menstruation may not be a surgical contraindication.