五种血栓评估表对股骨转子间骨折深静脉血栓形成的预测价值

Predictive value of five thrombotic risk assessment scales for deep vein thrombosis after intertrochanteric fracture of the femur

背景:股骨转子间骨折并发下肢深静脉血栓形成,一旦脱落导致肺栓塞可能危及生命。目前临床可用的深静脉血栓形成评估量表较多,但其在股骨转子间骨折患者中的应用价值尚未明确。目的:比较5种血栓风险评估量表对股骨转子间骨折患者下肢深静脉血栓形成发生的预测价值。方法:对西南医科大学附属医院骨科2016年7月至2021年7月收治的254例股骨转子间骨折住院患者资料进行回顾性分析,依据下肢静脉彩超检查结果,分为深静脉血栓形成组和非深静脉血栓形成组,依次选用Capprini、RAPT、Autar、Pauda及Wells量表对患者发生深静脉血栓形成的风险进行评定,比较两组患者5种血栓风险评估量表的评分;同时绘制受试者工作特征曲线,计算曲线下面积,分析5种血栓风险评估量表对股骨转子间骨折患者下肢深静脉血栓形成发生的预测价值。结果与结论:(1)深静脉血栓形成组患者的Wells评分、Autar评分及RAPT评分明显高于非深静脉血栓形成组(P<0.05);(2)Wells、Capprini、RAPT、Autar、Pauda评分量表的曲线下面积分别为0.916,0.751,0.767,0.544及0.575;(3)Wells、Capprini、RAPT、Autar、Pauda评分量表诊断股骨转子间骨折患者发生深静脉血栓形成的灵敏度分别为93.22%,77.97%,74.01%,58.76%及36.16%,特异度分别为64.94%,59.74%,35.06%,49.35%及74.03%;(4)上述5种血栓风险评估量表对股骨转子间骨折住院患者下肢深静脉血栓形成发生均有一定预测价值,但Wells风险评估量表预测价值相对较高,其次是Capprini与RAPT评估量表;Wells量表针对股骨转子间骨折住院患者发生血栓的风险评估价值较为准确,RAPT量表针对所有创伤骨科患者发生血栓的风险评估较为适用。

BACKGROUND:Once the deep vein thrombosis of the lower extremities caused by intertrochanteric fracture falls off,pulmonary embolism will be fatal.At this stage,there are many deep vein thrombosis evaluation scales available in clinical practice,but their application value in patients with intertrochanteric fractures of the femur is not clear.OBJECTIVE:To compare the predictive value of five different thrombosis risk assessment scales for lower extremity deep vein thrombosis in patients with intertrochanteric fractures of the femur.METHODS:The data of 254 patients with intertrochanteric fractures admitted to the Department of Orthopedics,Affiliated Hospital of Southwest Medical University from July 2016 to July 2021 were retrospectively analyzed.According to the examination results of the lower extremity venous ultrasound,the patients were divided into the deep vein thrombosis group and the non-deep vein thrombosis group.Capprini,RAPT,Autar,Pauda and Wells scales were used to evaluate the possible risk of deep vein thrombosis in patients.The scores of five thrombosis risk assessment scales were compared between the two groups.Simultaneously,the receiver operating characteristic curve was drawn and the area under the curve was calculated to analyze the predictive value of five thrombosis risk assessment scales for lower extremity deep vein thrombosis in patients with intertrochanteric fracture.RESULTS AND CONCLUSION:(1)The Wells score,Autar score and RAPT score in the deep vein thrombosis group were significantly higher than those in the non-deep vein thrombosis group(P<0.05).(2)The areas under the curve of Wells,Capprini,RAPT,Autar and Pauda were 0.916,0.751,0.767,0.544 and 0.575,respectively.(3)The sensitivities of Wells,Capprini,RAPT,Autar and Pauda in the diagnosis of deep vein thrombosis in patients with intertrochanteric fracture were 93.22%,77.97%,74.01%,58.76%and 36.16%,respectively.The specificities were 64.94%,59.74%,35.06%,49.35%and 74.03%,respectively.(4)All the above five thrombosis risk assessment scales have certain predictive values for the occurrence of deep vein thrombosis in the lower extremity of hospitalized patients with intertrochanteric fracture,but the Wells risk assessment scale has a relatively high predictive value,followed by Capprini and RAPT assessment scale.The risk assessment value of Wells scale is relatively accurate for whether the patients with intertrochanteric fracture have thrombus.The RAPT scale is applicable to the risk assessment of possible thrombosis in all orthopedic trauma patients.