肱骨近端骨折围手术期深静脉血栓发生因素分析

Related factors of occurrence of deep venous thrombosis in patients with proximal humerus fracture

目的探讨分析肱骨近端骨折深静脉血栓发生的危险因素。方法通过回顾性分析2021年1月到2022年1月天津医院上肢二病区肱骨近端骨折患者相关临床资料,对深静脉血栓形成的相关危险因素进行分析。结果肱骨近端骨折患者126例,年龄18~83岁,平均年龄(58.9±15.4)岁,围手术期出现血栓的患者40例,血栓发生率31.7%。使用Logistic多因素分析方法结果显示,年龄及身体质量指数是肱骨近端骨折围手术期患者血栓形成独立危险因素(P<0.05)。结论肱骨近端骨折术后深静脉血栓容易发生,肥胖及高龄为患者深静脉血栓的危险因素,对上述患者的预防与监测十分重要,以减少围手术期并发症的发生。

Background Proximal humeral fracture is a typical upper limb fracture in clinical practice,accounting for 5%-6%of the incidence of systemic fractures,which is the third most common fracture in the elderly population,and approximately 20%of proximal humeral fractures require surgical treatment.With the advent of the aging society,the incidence of proximal humerus fracture is increasing.In patients over 65,the incidence of proximal humeral fractures increases to 10%.Perioperative complications are noteworthy.Deep vein thrombosis(DVT)is the most common complication,likely leading to pulmonary embolism and increasing hospitalization costs.In recent years,many clinical studies have suggested that the incidence of DVT in Asia has shown a significant upward trend,which is directly related to the increased attention paid by clinicians and patients to DVT,so the discovery rate of DVT has increased yearly.According to Jang's research,the annual incidence of DVT in Asian populations shows a significant upward trend,especially in people over 60.Clinical studies in other parts of Asia also support this phenomenon.Although orthopedic surgeons routinely administer drug anticoagulation prevention to orthopedic inpatients at risk of DVT,thrombus still occurs in many patients.Perioperative thrombus in lower limb fractures has received much attention,especially in the distal femur,femoral shaft,and peri-hip fractures.However,there are few studies on perioperative thrombosis of upper extremity fractures,especially proximal humeral fractures.Objective To investigate the related factors of deep venous thrombosis in patients with proximal humeral fracture.Methods We prospectively included 126 patients with proximal humeral fractures admitted to Tianjin Hospital from January 2021 to January 2022.The baseline data and relevant laboratory indicators of these patients were collected.The incidence of deep vein thrombosis in patients with proximal humerus fracture was counted,and the related factors inducing deep vein thrombosis were analyzed.Results Deep venous thrombosis occurred in 40 of 126 patients,and the incidence was 31.7%.The ages ranged from 18 to 83,with an average age of 58.9±15.4.The Logistic regression model results showed that high BMI and old age were the risk factors of deep venous thrombosis in patients(OR>1,P<0.05).Conclusions Patients with proximal humeral fractures have a high risk of deep venous thrombosis.High BMI and old age are the risk factors of deep venous thrombosis in patients with proximal humerus fracture.