胫骨平台骨折术前下肢深静脉血栓形成的发生规律和危险因素

Risk factors for preoperative venous thromboembolism in patients with tibial plateau fracture

目的探讨胫骨平台骨折患者术前下肢深静脉血栓形成(DVT)的发生规律及危险因素。方法分析武汉市第四医院骨科手术治疗的224例胫骨平台骨折患者资料,依据术前彩超检查结果分为血栓组和无血栓组。分析患者一般情况,骨折情况及实验室数据,以单因素分析筛选危险因素,再用多因素Logistic回归分析确定独立危险因素。结果术前DVT发生率21.4%,以远端血栓为主;并发肺栓塞(PE)17例,其中单纯肌间静脉血栓合并PE 10例。血栓组48例,男23例,女25例;年龄(56.65±11.14)岁;Schatzker分型为Ⅰ型2例,Ⅱ型16例,Ⅲ型1例,Ⅳ型11例,Ⅴ型8例,Ⅵ型10例。非血栓组176例,男100例,女76例;年龄(49.15±12.56)岁;Schatzker分型为Ⅰ型4例,Ⅱ型62例,Ⅲ型9例,Ⅳ型45例,Ⅴ型37例,Ⅵ型19例。单因素分析:年龄(t=0.731,P<0.05)、肥胖[体重指数(BMI)≥25](t=5.068,P<0.05)、入院至手术时间(χ^(2)=9.060,P<0.05)、骨折至手术时间(χ^(2)=3.024,P<0.05)、血红蛋白(Hb)(χ^(2)=0.524,P<0.05)、入院D-二聚体(χ^(2)=11.575,P<0.05)、白蛋白(χ^(2)=0.303,P<0.05)为危险因素。多因素Logistic回归分析:年龄[比值比(OR)=1.040,95%可信区间(CI):1.005~1.078,P<0.05]、肥胖(BMI≥25)(OR=3.169,95%CI:1.425~7.050,P<0.05)、入院至手术时间(OR=1.24795%CI:1.030~1.510,P<0.05)和Hb(OR=0.974,95%CI:0.950~0.998,P<0.05)是独立危险因素。结论胫骨平台骨折术前DVT的发生率较高,多为远端血栓,对高龄、肥胖、贫血患者应积极抗凝,减少术前时间,降低DVT发生率。

Objective To investigate the epidemiology and the risk factors of preoperative deep venous thrombosis(DVT)in patients with tibial plateau fractures in order to guide antithrombotic therapy.Methods A total of 224 patients undergoing surgeries were included at Wuhan Fourth Hospital.Duplex ultrasonography at admission and before operation was used to screen for DVT of the bilateral lower extremities.Patients were divided into DVT group and non-DVT group.Data on demographics,fracture related information,laboratory biomarkers were collected and compared between groups with and without DVT.Results The incidence of preoperative DVT was 21.4%(48/224),mainly involving distal thrombosis.There were 17 patients with pulmonary embolism(PE),including 10 patients with simple intramuscular vein thrombosis.48 cases in DVT group,23 were males and 25 were females.The average age was(56.65±11.14).There were 2 cases belonged to SchatzkerⅠ,16 toⅡ,1 toⅢ,11 toⅣ,8 toⅤ,and 10 toⅥ.176 cases in non-DVT group,100 were males and 76 were females.The average age was(49.15±12.56).There were 4 cases belonged to SchatzkerⅠ,62 toⅡ,9 toⅢ,45 toⅣ,37 toⅤ,and 19 toⅥ.Univariate analysis showed that age(t=0.731,P<0.05),obesity[body mass index(BMI)≥25](t=5.068,P<0.05),time from admission to surgery(χ^(2)=9.060,P<0.05),time from fracture to surgery(χ^(2)=3.024,P<0.05),hemoglobin(χ^(2)=0.524,P<0.05),D-dimer at admission(χ^(2)=11.575,P<0.05),serum albumin(χ^(2)=0.303,P<0.05)were statistically different than those in non-DVT group.Multivariate analysis showed age[odds ratio(OR)=1.040,95%confidence interval(CI):1.005-1.078,P<0.05],obesity(BMI≥25)(OR=3.169,95%CI:1.425-7.050,P<0.05),time from admission to surgery(OR=1.247,95%CI:1.030-1.510,P<0.05)and hemoglobin(OR=0.974,95%CI:0.950-0.998,P<0.05)were independent risk factors.Conclusion The incidence of preoperative DVT in patients with tibial plateau fractures is high,and distal thrombosis is predominated.Age,obesity,time from admission to surgery and hemoglobin decreased are independent risk factors of preoperative DVT.