下肢单一骨折后围手术期深静脉血栓发生率及部位分析

Analysis of the incidence and location of perioperative deep vein thrombosis in single fracture of lower extremity

目的分析下肢单一骨折后围手术期深静脉血栓(DVT)形成率与骨折部位、血管位置的相关性。方法回顾性分析2013年1月-2017年12月汉中市中心医院创伤骨科收治1 107例下肢单一骨折患者,其中男性438例(39.6%),女性669例(60.4%);平均年龄68.1岁(18~91岁)。观察患者手术前后双下肢静脉超声结果,并分析不同静脉部位DVT与围手术期症状性肺栓塞(PE)的相关性。结果 1107例中发生DVT 789例(71.3%),术前确诊326例(29.4%),其中近端DVT 42例(3.8%),远端284例(25.7%);术后确诊463例(41.8%),其中近端DVT 65例(5.9%),远端398例(36.0%)。术后DVT发生率显著高于术前(41.8%vs.29.4%,P<0.05),远端静脉DVT发生率显著高于近端静脉(61.6%vs.9.7%,P<0.05)。术前骨折同侧下肢和骨折对侧下肢DVT发生率与术后比较差异无统计学意义(P>0.05),但术后双侧下肢DVT发生率显著高于术前(13.6%vs.3.3%,P<0.05)。术前骨折对侧下肢近端静脉DVT发生率与术后比较差异无统计学意义(P>0.05),但术后骨折对侧下肢近端静脉DVT发生率显著高于术前(15.7%vs.4.7%,P<0.05)。症状性PE发生率为1.4%(16/1107),近端静脉DVT患者PE发生率显著高于远端静脉DVT患者(11.2%vs.0.6%,P<0.05)。结论下肢单一骨折患者术后DVT发生率高于术前,尤其是术后双侧下肢DVT发生率升高。DVT主要位于远端静脉、且症状性PE发生率较低,但近端静脉DVT患者的症状性PE发生率较高。

Objective To analyze the correlation between the formation rate of perioperative deep vein thrombosis(DVT) and the location of fracture and blood vessel after single fracture of lower extremity.Methods Totally 1,107 patients with single fracture of lower extremity who were treated in the Department of Orthopaedics,Hanzhong Central Hospital between Jan.2013 to Dec.2017 were enrolled,including 438 males(39.6%) and 669 females(60.4%) with the average age of 68.1 years(18-91 years).The results of venous ultrasound of the lower extremities before and after surgery were observed,and the correlation between DVT in different venous location and perioperative symptomatic pulmonary embolism(PE) was analyzed.Results A total of 789 cases(71.3%)developed DVT,among whom 326 patients(29.4%) were diagnosed with preoperative DVT,including 42(3.8%) proximal DVT and 284(25.7%) distal DVT;463(41.8%) were diagnosed with postoperative DVT,including 65(5.9 %) proximal DVT and 398(36.0%) distal DVT.The incidence of postoperative DVT was significantly higher than that of preoperative(41.8% vs.29.4%,P<0.05).The incidence of distal DVT was significantly higher than that of proximal(61.6% vs.9.7%,P<0.05).There was no significant difference in the incidence of DVT between the ipsilateral lower extremities and the contralateral lower extremities(P>0.05),but the incidence of bilateral lower extremity DVT postperatively was significantly higher than preoperatively(13.6% vs.3.3%,P<0.05).There was no significant difference in the incidence of the lower extremities proximal DVT of the patients with fractures between preoperatively and postoperatively(P>0.05),but the incidence of postoperative DVT in the proximal lower extremities was significantly higher than preoperatively(15.7% vs.4.7%,P<0.05).The incidence of symptomatic PE was 1.4%,and the incidence of PE in patients with proximal DVT was significantly higher than that in patients with distal DVT(11.2% vs.0.6%,P<0.05).Conclusion The incidence of postoperative DVT in patients with single fracture of lower extremity was higher than preoperatively,especially in the incidence of DVT in both lower extremities.DVT is mainly located in the distal vein,and the incidence of symptomatic PE is lower,but the incidence of symptomatic PE is higher in patients with proximal venous DVT.