血栓弹力图在胫腓骨骨折术后深静脉血栓形成的预测意义

Significance of thromboelastography in predicting deep vein thrombosis after tibiofibular fractures

目的通过检测胫腓骨骨折患者术后血栓弹力图(TEG)和D-二聚体等指标结合术后下肢静脉血栓的发生情况,探讨TEG对骨折后下肢深静脉血栓形成的预测意义。方法收集辽阳市中心医院2018年1月至2019年6月收治的胫腓骨骨折患者100例,所有患者于术后第二天进行血栓弹力图、D-二聚体和血常规的检测。根据术后30 d内下肢静脉彩超的结果将患者分为血栓形成组和血栓未形成组,并收集30名同时期健康人做为对照组。分析各组血栓弹力图的R值、K值、α角、MA值、CI值及D-二聚体、纤维蛋白原(Fib)血小板数值以及红细胞分布宽度。结果经下肢静脉彩超判定有14例患者发生下肢深静脉血栓(DVT),血栓最大弹力度(MA值)、D-二聚体在血栓形成组、血栓未形成组和对照组间均有统计学差异(P<0.05)。TEG MA值曲线下面积为0.92(95%置信区间0.85~0.98,P=0.000)D-二聚体曲线下面积为0.85(95%置信区间为0.76~0.95,P=0.000)。结论血栓弹力图的MA值对胫腓骨骨折术后患者下肢深静脉血栓形成有一定的预测意义。

【Objective】To investigate the predictive significance of thrombelastography(TEG)for deep venous thrombosis in lower extremity after fracture by detecting thromboelastography and other coagulation indicators in patients with tibiofibular fractures.【Methods】One hundred patients with tibiofibular fractures admitted to Liaoyang Central Hospital from January 2018 to June 2019 were selected.All patients underwent thrombogram,D-dimer and routine blood tests on the second day after surgery.Within 30 days after the operation,the patients were divided into the thrombosis group and the non-thrombosis group according to the results of lower limb vein ultrasound,and 30 healthy people at the same time were collected as the control group.The R value,K value,alpha angle,MA value,confidence interval value,D-dimer,fibrinogen,platelet value and RBC distribution width of each group were analyzed.【Results】There were 14 patients with lower extremity deep venous thrombosis determined by color ultrasound of lower extremity veins,and there were statistical differences in maximum strength of thrombosis(MA value)and Ddimer between the thrombosis group,the non-thrombosis group and the control group(P<0.05).The area under the curve of TEG MA value was 0.92(95%confidence interval 0.85~0.98,P=0.000).The area under the curve of D-dimer was 0.85(95%confidence interval 0.76~0.95,P=0.000).【Conclusion】The MA value of thromboelastic diagram can predict the formation of lower extremity deep venous thrombosis in patients with tibiofibular fracture.