单一下肢闭合骨折围手术期深静脉血栓形成的部分影响因素分析

Analysis of some influencing factors on deep venous thrombosis of lower extremity in patients with lower extremity isolated closed fracture

目的探讨年龄、性别、身体质量指数(body mass index, BMI)及骨折部位对单一下肢闭合骨折围手术期下肢深静脉血栓形成(deep vein thrombosis, DVT)的影响。方法回顾性分析西安交通大学医学院附属红会医院2015年1月至2017年12月符合纳入条件的325例下肢骨折病人的临床资料,其中男155例,女170例,年龄为(58.41±19.82)岁(19~94岁),BMI为(23.22±3.71)kg/m2(15.59~35.16 kg/m2);髋部骨折185例,股骨干骨折12例,膝关节周围骨折66例,胫腓骨干骨折25例,踝关节骨折27例,足部骨折10例。手术前后分别行双下肢静脉彩色多普勒超声检查,根据双下肢静脉超声结果将病人分为术前有血栓组和术前无血栓组、术后血栓组和术后无血栓组,分别对病人的年龄、性别、BMI及骨折部位进行统计分析。先采用单因素分析筛选危险因素,再采用多因素Logistic回归分析确定主要的独立危险因素。结果术前有100例病人发生DVT,发生率为30.77%,术后有166例病人发生DVT,发生率为51.08%;发病率在前三位的年龄段依次为60~74岁、≥75岁、45~59岁;女性病人更易发生DVT;按BMI分组后,术前术后各个组DVT发生率的差异无统计学意义;骨折部位以髋部以远、膝关节以近骨折(包括膝关节周围骨折)的DVT发生率最高。结论髋部以远、膝关节以近骨折(包括膝关节周围骨折)及60岁以上的女性病人是下肢单一闭合骨折DVT的主要影响因素,应给予足够预防性抗凝治疗,防止发生致命性肺栓塞。

Objective To investigate the effects of age, gender, body mass index(BMI) and fracturesite on deep vein thrombosis(DVT) of patients with lower extremity isolated closed fractures. Methods Aretrospective analysis was performed on 325 patients with lower extremity closed fracture from January 2015 toDecember 2017 in Xi.an Honghui Hospital, including 155 male and 170 female. The age was(58.41±19.82)years(19-94 years). BMI was(23.22±3.71) kg/m2(15.59-35.16 kg/m2). There were 185 case of hip fracture, 12 cases of femoral shaft fracture, 66 cases of peri-knee fracture, 25 cases of tibiofibular shaft fracture, 27 cases ofankle fracture, and 10 cases of foot fracture. Color Doppler ultrasonography was performed on the veins of bothlower limbs. According to whether thrombosis occurred or not, the patients were divided into thrombotic groupand non-thrombotic group before and after operation. The age, sex, BMI and fracture site in the two groups werestatistically analyzed. Risk factors were screened by the univariate analysis, and the multivariate logisticregression analysis was used to determine the main independent risk factors. Results There were 100 patientswith DVT before operation with the incidence being 30.77%. DVT occurred in 166 patients after operation withthe incidence being 51.08%. The incidence of the top three was 60-74 years old, ≥75 years old, and 45-59 years old. Female patients were more likely to develop DVT, and grouped by BMI, there was no significantdifference between the groups before and after surgery. The incidence of DVT was the highest in the fracture sites of distal hip, and proximal fracture of the knee(including peri-knee fracture). Conclusion Distal hip,proximal fracture of the knee(including peri-knee fracture) and females over 60 years old are the maininfluencing factors of DVT in isolated closed fracture of lower extremity. Sufficient preventive anticoagulationtherapy should be given to prevent fatal pulmonary embolism.