胫骨平台骨折患者术前下肢深静脉血栓形成的危险因素分析

Risk factors of preoperative deep venous thrombosis of lower extremities in patients with tibial plateau fractures

目的探讨胫骨平台骨折术前下肢深静脉血栓形成的相关危险因素。方法收集自2020-01—2022-01笔者所在科室行手术治疗的218例胫骨平台骨折患者的相关术前资料,根据术前是否发生下肢深静脉血栓形成将其分为血栓组和非血栓组,记录患者年龄、性别、Schatzker骨折分型、合并基础病、合并其他骨折、骨折至手术时间、骨牵引以及相关血清学等指标,先行单因素分析初步筛选危险因素,再运用多因素Logistic回归分析确定独立危险因素,并采用ROC曲线评估各独立危险因素及其联合模型对胫骨平台骨折术前下肢深静脉血栓形成发生的预测价值。结果术前共发现下肢深静脉血栓形成55例(25.2%),主要以胫后和肌间静脉为主。单因素分析结果显示,年龄、骨折至手术时间、Schatzker骨折分型和D-二聚体是胫骨平台骨折术前下肢深静脉血栓形成发生的危险因素(P<0.05);对上述4个因素进行二分类Logistic回归分析,结果显示年龄、骨折至手术时间和D-二聚体是其独立危险因素(P<0.05)。进一步对各独立危险因素进行ROC曲线分析,结果显示年龄、骨折至手术时间和D-二聚体的ROC曲线下面积分别为0.627(P=0.005)、0.773(P<0.001)和0.604(P=0.021);而且当年龄>48.5岁、骨折至手术时间>8.5 d和D-二聚体水平>7.51 ng/mL时,是预测胫骨平台骨折术前下肢深静脉血栓形成的最佳切点,其联合模型预测的准确率为80.7%。结论胫骨平台骨折术前下肢深静脉血栓形成的发生率较高,以远端血栓为主;年龄、骨折至手术时间和D-二聚体是其发病的独立危险因素,其联合模型具有良好的诊断效能。

Objective To investigate the risk factors of preoperative deep venous thrombosis of lower extremities in patients with tibial plateau fractures.Methods The relevant preoperative data of 218 patients with tibial plateau fractures who underwent surgical treatment in the author’s department from January 2020 to January 2022 were collected.The patients were divided into thrombosis group and non-thrombosis group according to whether they had deep venous thrombosis of the lower extremities before operation.The patient's age,gender,Schatzker fracture classification,combined underlying diseases,combined other fractures,time from fracture to operation,bone traction and related serological indicators were recorded.Univariate analysis was performed to screen the risk factors,followed by multivariate Logistic regression analysis to determine the independent risk factors.Receiver operating characteristic curve was used to evaluate the predictive value of each independent risk factor and its combined model for the occurrence of preoperative deep venous thrombosis of lower extremities.Results A total of 55 cases(25.2%)of deep venous thrombosis of the lower extremities were found before operation,mainly in the posterior tibial and intermuscular veins.Univariate analysis showed that age,time from fracture to operation,Schatzker fracture classification,and D-dimer were risk factors for preoperative deep venous thrombosis of lower extremities in patients with tibial plateau fracture(P<0.05).Binary Logistic regression analysis showed that age,time from fracture to operation and D-dimer were independent risk factors(P<0.05).ROC curve analysis of independent risk factors showed that the area under the curve of age,time from fracture to operation and D-dimer were 0.627(P=0.005),0.773(P<0.001)and 0.604(P=0.021),respectively.In addition,age>48.5 years,time from fracture to operation>8.5 days,and D-dimer level>7.51 ng/mL were the best cut points to predict preoperative DVT of lower extremity in patients with tibial plateau fracture,and the prediction accuracy of the combined model was 80.7%.Conclusion The incidence of preoperative deep venous thrombosis of lower extremities in tibial plateau fractures is high,and the distal thrombosis is the main type.Age,time from fracture to operation and D-dimer are independent risk factors for the onset of the disease,and the combined model has good diagnostic efficiency.