下肢开放性骨折患者深静脉血栓形成的研究

Study on deep venous thrombosis in patients with open fracture of lower extremities

目的探讨下肢开放性骨折患者深静脉血栓形成的发生规律及其相关因素。方法采用回顾性研究方法,对2015年1月-2017年11月西安交通大学医学院附属红会医院创伤骨科收治的203例诊断为下肢开放性骨折的患者的临床资料进行分析,其中男性148例,女性55例;平均年龄47.3岁,年龄范围18~63岁。下肢开放性骨折部位分类:股骨干开放性骨折59例;胫腓骨开放性骨折107例;踝关节开发性骨折37例。开放性骨折Gustilo分型I型34例,II型71例,HI型98例。根据是否发生血栓分为血栓组(n=63)及非血栓组U=140),记录并统计分析血栓发生的例数、发病率及发生部位。血栓的发病率以百分比(%)表示,血栓组与非血栓组的年龄、骨折程度、受伤类型、开放性骨折Gustilo分型、性别,体重指数(BMI),合并内科疾病,骨折部位,术前、术后D-二聚体进行;检验或Fisher精确检验法,检验水准值取双侧0.05。P<0.05认为差异有统计学意义。结果63例开放性骨折患者发生深静脉血栓,发病率为31.03%,其中:5例为中央型血栓(7.93%);17例为混合型血栓(26.98%);41例为周围型血栓(65.08%),血栓主要以周围型血栓为主。血栓组与非血栓组患者的年龄、骨折程度、受伤类型、开放性骨折Gustilo分型比较差异具有统计学意义(P<0.05),性别,BMI值,合并内科疾病,骨折部位,术前、术后D-二聚体比较差异无统计学意义(P>0.05)。结论下肢开放性骨折患者深静脉血栓的发病率较高,血栓主要以周围型血栓为主。年龄多60岁、高处坠落伤、2处及以上骨折及粉碎性骨折、开放性骨折Gustilo分型瓜型与深静脉血栓形成的发生相关。

Objective To investigate the incidence and risk factors of deep venous thrombosis in patients with open fracture of lower extremities.Methods A retrospective study was conducted to analyze the clinical data of 203 patients with open fracture of lower limbs admitted to Department of Orthopaedics and Trauma,Xi'an Jiangtong University Medical College Red Cross Hospital from January 2015 to November 2017.There were 75 males and 45 females,the average age was 47.3 years,and the age ranged from 18 to 63 years.Classification of open fracture sites of lower limbs:open fracture of femoral shaft in 59 cases;open fracture of tibia and fibula in 107 cases;open fracture of ankle in 37 cases.Gustilo classification of open fracture included 34 cases of typeⅠ,71 cases of typeⅡand 98 cases of typeⅢ.According to whether thrombosis occurs or not,the patients were divided into thrombosis group(n=63)and non-thrombosis group=140).The incidence of thrombosis was expressed as percentage(%).The age,fracture degree,injury type,Gustilo classification of open fracture,gender,body mass index(BMI),combined medical diseases,fracture site,preoperative and postoperative D-dimers were subjected to^2 test or Fisher;s exact test.The test a value was taken as 0.05 on both sides.P<0.05 suggested that the difference was statistically significant.Results The incidence of deep venous thrombosis in 63 cases of open fracture was 31.03%,of 63 DVT patients,5 were central thrombosis(7.93%),17 were mixed thrombosis(26.98%)and 41 were peripheral thrombosis(65.08%).The main type of thrombosis was peripheral thrombosis.There were significant differences in age,fracture degree,injury type and open fracture Gustilo type between the two groups of thrombus group and non thrombus group(P<0.05).Sex,BMI,internal medical diseases,fracture sites,and D-two polymer before and after operation were not statistically significant(P>0.05).Conclusions The incidence of DVT was higher in patients with open fracture of lower extremities,the main type of thrombosis was peripheral thrombosis.Age over 60 years old,high falling injury,2 or more fractures and comminuted fractures,open fractures Gustilo typeⅢwas associated with DVT.