RAPT评分联合血栓弹力图K值及α角对创伤性骨折患者术后发生下肢深静脉血栓的诊断价值

Diagnostic value of RAPT score combined with K value andαangle of thromboelastography in predicting postoperative deep vein thrombosis of the lower extremities in patients with traumatic fracture

目的探讨血栓形成危险度评分量表(RAPT)评分联合血栓弹力图K值及α角对创伤性骨折患者术后发生下肢深静脉血栓(DVT)的诊断价值。方法选取2022年1月至2023年6月重庆医科大学附属永川医院骨科收治的因创伤性骨折住院的178例患者作为研究对象。根据患者手术后双下肢静脉彩超检查结果,将其分为DVT组(72例)与非DVT组(106例)。对手术后的患者进行RAPT评分,记录血栓弹力图K值和α角。采用多因素Logistic回归分析RAPT评分、K值、α角对创伤性骨折患者术后发生下肢DVT的危险因素。绘制受试者工作特征(ROC)曲线评估RAPT评分、K值、α角单独及3项指标联合检测对创伤性骨折患者术后发生下肢DVT的诊断价值。结果DVT组RAPT评分高于非DVT组,α角大于非DVT组,K值低于非DVT组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,RAPT评分升高、α角增大、K值减小为创伤性骨折患者术后发生下肢DVT的危险因素(P<0.05)。ROC曲线分析结果显示,RAPT评分、K值、α角单独诊断创伤骨折患者术后发生下肢DVT的曲线下面积分别为0.866、0.813、0.842,均低于3项指标联合诊断的0.913。结论RAPT评分联合血栓弹力图K值及α角对创伤性骨折患者术后发生下肢DVT具有较高的诊断价值。

Objective To investigate the diagnostic value of risk assessment profile for thromboembolism(RAPT)score combined with K value andαangle of thromboelastography in the occurence of postoperative deep vein thrombosis(DVT)of lower extremities in patients with traumatic fracture.Methods A total of 178 patients with traumatic fractures admitted to the Department of Orthopedics,Yongchuan Hospital Affiliated to Chongqing Medical University from January 2022 to June 2023 were selected as the research objects.According to the results of postoperative lower extremity venous color Doppler ultrasound examination,the patients were divided into DVT group(72 cases)and non-DVT group(106 cases).The RAPT score,K value andαangle of thromboelastography were recorded in postoperative patients.Multivariate Logistic regression was used to analyze the risk factors of RAPT score,K value andαangle on postoperative lower extremity DVT in patients with traumatic fracture.The receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of RAPT score,K value andαangle alone and the 3 indicators in combination for postoperative DVT of the lower extremities in patients with traumatic fracture.Results The RAPT score of the DVT group was higher than that of the non-DVT group,theαangle of the DVT group was larger than that of the non-DVT group,and the K value was lower than that of the non-DVT group,and the differences were statistically significant(P<0.05).The results of multivariate Logistic regression analysis showed that the increase of RAPT and the increase ofαangle and the decrease of K value were the risk factors for the occurrence of postoperative lower extremities DVT in patients with traumatic fracture(P<0.05).ROC curve analysis results showed that the area under the curve of RAPT score,K value,andαangle in the diagnosis of postoperative lower extremity DVT in patients with traumatic fracture were 0.866,0.813,and 0.842 respectively,which were lower than the 0.913 of combined diagnosis of the 3 indicators.Conclusion The RAPT score combined with K value andαangle of thromboelastography has a high diagnostic value for postoperative DVT of the lower extremities in patients with traumatic fracture.