髋关节骨折患者术前深静脉血栓形成的危险因素分析

Risk factors of preoperative deep venous thrombosis in patients with hip fracture

目的基于结构方程模型探讨髋关节骨折患者术前深静脉血栓(DVT)形成的发生率及其危险因素。方法纳入我院120例接受手术治疗的髋关节骨折患者为研究对象,根据术前是否发生DVT分为DVT组和非DVT组。单因素分析2组患者间差异,多因素Logistic回归模型分析术前DVT形成的独立危险因素。ROC曲线分析独立危险因素和各独立危险因素联合模型对DVT的预测作用,应用AMOS 23.0软件构建DVT的结构方程模型。结果术前共28例(23.33%)患者发生DVT。单因素结果显示,2组患者年龄、BMI、是否合并内科基础疾病、受伤距手术时间、D-二聚体及血红蛋白比较,差异均具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄>60岁、BMI>25 kg/m^(2)、合并内科基础疾病及受伤距手术时间>5 d均是术前DVT形成的独立危险因素(P<0.05)。各独立危险因素联合模型的曲线下面积(AUC)为0.907(95%CI0.828~0.936)。结构方程模型中年龄、BMI、合并内科基础疾病及受伤距手术时间的路径系数均有统计学差异(P<0.05),模型可决系数为0.32。结论年龄>60岁、BMI>25 kg/m^(2)、合并内科基础疾病及受伤距手术时间>5 d均是髋关节骨折患者术前DVT形成的独立危险因素,联合各独立危险因素对DVT进行预测价值更高。

Objective To investigate the incidence and risk factors of preoperative deep venous thrombosis(DVT)in patients with hip fracture on basis of structural equation model.Methods A total of 120 patients with hip fracture who received surgical treatment in our hospital were included as the study subjects.These patients were divided into the DVT group and the non-DVT group according to whether DVT occurred before surgery.Univariate analysis was used to analyze the differences between the two groups,and multivariate Logistic regression model was used to analyze the independent risk factors for the formation of preoperative DVT.ROC curve was used to analyze the predictive effect of independent risk factors and the combined model of each independent risk factor on DVT,and the structural equation model of DVT was built by AMOS 23.0 software.Results A total of 28 patients(23.33%)developed DVT before surgery.Univariate results showed that there were statistically significant differences in age,BMI,whether living with underlying medical diseases,time from injury to surgery,D-dimer and hemoglobin between the two groups(P<0.05).Multivariate Logistic regression analysis showed that age>60 years old,BMI>25 kg/m^(2),combined with underlying medical diseases,and the time from injury to surgery>5 days were all the independent risk factors for the formation of preoperative DVT(P<0.05).The area under curve(AUC)of the combined model of each independent risk factor was 0.907(95%CI:0.828 to 0.936).In the structural equation model,there were statistically significant differences in path coefficient of age,BMI,combined with underlying medical diseases and time from injury to surgery(P<0.05),and the model’s determination coefficient was 0.32.Conclusion Age>60 years old,BMI>25 kg/m^(2),combined with underlying medical diseases,and the time from injury to surgery>5 days were all the independent risk factors for preoperative DVT in patients with hip fracture.Combined with independent risk factors have higher predictive value for DVT.