膝关节周围骨折病人术后下肢深静脉血栓形成的危险因素分析

Risk factors of deep vein thrombosis of lower limbs in patients with peri-knee fractures

目的探讨膝关节周围骨折病人术后下肢深静脉血栓形成(deep vein thrombosis,DVT)的危险因素。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月至2018年12月收治的497例膝关节周围骨折且术前超声检查未发现DVT的病人的临床资料,根据术后超声检查结果将病人分为血栓组和无血栓组,记录血栓发生部位及发生率,将年龄、性别、骨折部位、骨折侧别、合并外伤、合并内科疾病、美国麻醉医师协会(America Society of Anesthesiologists,ASA)分级、术中失血量、术中输液量、术中输血量、止血带使用时间、手术时间、术后1 d血红蛋白、术后1 d红细胞压积、术后1 d的D-二聚体列为观察指标,先后采用单因素分析和多因素Logistic回归分析确定术后DVT的独立危险因素。结果497例病人中,术后有175例发生DVT,发生率为35.21%,其中发生近端血栓2例(2/175,1.14%),远端血栓162例(162/175,92.57%),混合血栓11例(11/175,6.29%)。单因素分析结果显示两组间年龄、性别、冠状动脉粥样硬化性心脏病(冠心病)、术后1 d D-二聚体的差异均有统计学意义(P均<0.05)。多因素Logistic回归分析结果提示年龄>60岁[OR=1.888,95%CI(1.213,2.930),P=0.005)、女性[OR=1.841,95%CI(1.268,2.673),P=0.001]、冠心病[OR=1.086,95%CI(1.190,3.945),P=0.011]、术后1 d D-二聚体[OR=1.077,95%CI(1.019,1.138),P=0.009]是术后DVT的独立危险因素。结论膝关节周围骨折病人术后DVT发生率较高,以远端DVT为主。对于年龄>60岁、女性、冠心病、术后D-二聚体升高的病人应注意重点预防下肢DVT的发生,防止发生致命性肺栓塞。

Objective To investigate the risk factors of lower limb deep vein thrombosis(DVT)in patients with peri-knee fracture after operation.Methods The clinical data of 497 patients with peri-knee fractures treated by trauma orthopaedics in Honghui Hospital Affiliated to Medicine College of Xian Jiaotong University from September 2014 to December 2018 were retrospectively analyze and no DVT was found by Bultrasound before operation.According to the results of postoperative ultrasound,the patients were divided into thrombus group and non-thrombus group.The incidence and location of thrombus were recorded,and the age,gender,fracture site,fracture side,combined trauma,combined medical disease,American Society of Anesthesiologists(ASA)classification,intraoperative blood loss,intraoperative infusion volume,intraoperative blood transfusion volume,tourniquet time,operation time,hemoglobin at 1st day after operation,hematocrit at 1st day after operation,and D-dimer at 1st day after operation between two groups were analyzed statistically.Univariate analysis and multivariate logistic regression analysis were used to determine the independent risk factors for postoperative DVT.Results Of the 497 patients,175 developed DVT after operation,with an incidence of 35.21%,including proximal thrombosis in 2 cases(2/175,1.14%),distal thrombus in 162 cases(162/175,92.57%),and mixed thrombus in 11 cases(11/175,6.29%).Univariate analysis showed statistically significant differences in age,gender,coronary atherosclerotic heart disease(coronary heart disease),and D-dimer at 1st day after operation between the two groups(all P<0.05).Multivariate logistic regression analysis showed that age>60 years[OR=1.888,95%CI(1.213,2.930),P=0.005],gender[OR=1.841,95%CI(1.268,2.673),P=0.001],coronary heart disease[OR=1.086,95%CI(1.190,3.945),P=0.011],D-dimer on the postoperative day 1[OR=1.077,95%CI(1.019,1.138),P=0.009]were independent risk factors of postoperative DVT.Conclusion The incidence of postoperative DVT was higher in patients with peri-knee fracture,mainly distal DVT.For female patients over 60 years old,with coronary heart disease and postoperative elevated D-dimer,attention should be paid to the prevention of lower limb DVT and fatal pulmonary embolism.