中青年髋部骨折患者围术期并发下肢深静脉血栓的发生率及危险因素分析

Analysis of the incidence and risk factors of perioperative deep vein thrombosis in the middle-aged and young people with hip fracture

目的探讨中青年髋部骨折患者围术期并发下肢深静脉血栓(deep venous thrombosis,DVT)的发生率及危险因素分析。方法回顾性分析2015年9月至2019年12月我院创伤骨科收治的186例中青年髋部骨折患者临床资料,其中男116例,女70例,年龄18~60岁,平均(47.96±11.35)岁,股骨颈骨折117例,转子间骨折44例,转子下骨折25例,其中合并其它部位骨折31例。入院、术前3天及术后3天每天行双下肢深静脉检查。收集记录患者的一般资料,包括年龄、性别、骨折部位、受伤原因、是否合并其它部位骨折、是否合并内科疾病(原发性高血压、2型糖尿病、冠心病)、ASA分级、术中失血量、术中输血量、手术时间、血清学指标、受伤至入院时间。结果本组中77例发生下肢DVT,发病率为41.40%,其中男52例(67.53%),女25例(32.47%)。11例(14.29%)为混合型血栓,4例(5.19%)为近端血栓,66例(80.52%)为远端血栓。合并其它部位骨折(OR=2.534,95%CI 1.045~6.145,P=0.040)、受伤至入院时间(OR=1.181,95%CI 1.049~1.330,P=0.006)、术后1天D-二聚体(OR=1.052,95%CI 1.007~1.098,P=0.023)是围术期DVT形成的独立危险因素。结论中青年髋部骨折患者围术期下肢DVT形成的风险性高,当患者延迟入院、合并多发伤时因尽早行双下肢超声检查,并动态监测D-二聚体,及时发现下肢DVT,减少患者发生肺栓塞的风险,提高患者的生活质量。

Objective To explore the incidence and risk factors of perioperative deep vein thrombosis of lower extremities in the young and middle-aged hip fracture patients.Methods A retrospective study of the data of186 young and middle-aged hip fracture patients,admitted to the Department of Traumatology and Orthopedics of Xi’an Honghui Hospital from September 2015 to December 2019,was conducted.There were 116 males and 70 females aged 18-60 years (47.96±11.35).There were 117 cases of femoral neck fracture,44 cases of intertrochanteric fracture,25 cases of subtrochanteric fracture,among whom 31 cases were combined with other fractures.Deep vein examinations of both lower extremities were performed every day on admission,3 days before surgery and 3 days after surgery.General information including age,gender,fracture site,cause of injury,combined fractures,combined medical diseases (primary hypertension,type 2 diabetes,coronary heart disease),ASA classification,intraoperative blood loss,intraoperative blood transfusion,operation time,serological indicators and time from injury to hospital admission were collected and recorded.Results DVT was noted in 77 patients with an incidence rate of 41.40%,including 52 males (67.53%) and 25 females (32.47%).Mixed thrombus was observed in 11 cases (14.29%),proximal thrombus in 4 cases (5.19%),and distal thrombus in 66 cases (80.52%).Combined fractures (OR=2.534,95% CI 1.045-6.145,P=0.040),time from injury to hospital admission (OR=1.181,95% CI 1.049-1.330,P=0.006) and D-Dimer 1 day after operation (OR=1.052,95% CI 1.007-1.098,P=0.023) were independent risk factors for DVT perioperatively.Conclusions Young and middle-aged patients with hip fracture have a higher risk of lower extremity DVT perioperatively.Early ultrasound examination of both lower extremities and dynamical monitor of D-dimer are recommended to reduce the risk of pulmonary embolism when the patient is delayed in hospitalization or complicated with multiple injuries.