股骨粗隆间骨折股骨近端防旋髓内钉内固定术后新发下肢深静脉血栓形成的危险因素分析

Analysis of risk factors for new onset lower limb deep venous thrombosis after treatment of femoral intertrochanteric fractures with proximal femoral nail antirotation internal fixation

目的分析股骨近端防旋髓内钉(Proximal femoral nail antirotation,PFNA)内固定治疗股骨粗隆间骨折术后新发下肢深静脉血栓形成(Deep venous thrombosis,DVT)的危险因素。方法回顾性分析自2021-03—2022-10采用PF⁃NA内固定治疗的183例股骨粗隆间骨折,根据术后彩色多普勒超声检查结果评估患者是否新发下肢DVT,将新发下肢DVT患者纳入DVT组,将未新发下肢DVT患者纳入无DVT组。比较两组性别、年龄、体质量指数、致伤原因、合并内科疾病、骨折侧别、骨折AO分型、是否O型血、骨折至手术时间、麻醉方式、术中出血量、术中输液量、围术期输血量,术前及术后第2天血脂四项,以及术前及术后第2天凝血功能,采用单因素分析和多因素Logistic回归分析确定新发下肢DVT的独立危险因素。结果183例中54例术后新发下肢DVT,发生率29.5%。中央型血栓2例,混合型血栓6例,周围型血栓46例,所有患者均未出现肺栓塞。DVT组与无DVT组在体质量指数、合并内科疾病、骨折侧别、骨折AO分型、O型血患者比例、骨折至手术时间、麻醉方式、术中出血量,术前血脂四项、凝血功能,以及术后第2天HDL-C、ATPP方面差异无统计学意义(P>0.05)。DVT组与无DVT组在性别、年龄、致伤原因、手术时间、术中输液量、围手术期输血量,以及术后第2天TC、TG、LDL-C、D-二聚体、FIB方面差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示年龄、术中输液量、围手术期输血量、术后第2天D-二聚体水平与股骨粗隆间骨折PFNA内固定术后新发DVT显著相关。结论股骨粗隆间骨折PFNA内固定术后新发下肢DVT的发病率较高,但是以周围型血栓为主,高龄、术中输液量大、围手术期输血量大、术后D-二聚体升高更容易导致下肢DVT发生。

Objective To analyze the risk factors for new onset lower limb deep venous thrombosis(DVT)after proximal femo⁃ral nail antirotation(PFNA)internal fixation for femoral intertrochanteric fractures.Methods A retrospective analysis was con⁃ducted on 183 patients with femoral intertrochanteric fractures who underwent PFNA internal fixation from March 2021 to Octo⁃ber 2022.Patients were assessed for new onset lower limb DVT based on postoperative color Doppler ultrasonography results.Patients with new onset lower limb DVT were included in the DVT group,while those without were included in the non-DVT group.The gender,age,body mass index,cause of injury,combined medical diseases,side of fracture,AO classification of frac⁃ture,proportion of patients with blood type O,time from fracture to operation,anesthesia method,intraoperative blood loss,in⁃traoperative infusion volume,perioperative blood transfusion volume,blood lipid before and on the second day after operation,and coagulation function before and on the second day after operation were compared between the two groups.Univariate analy⁃sis and multivariate Logistic regression analysis were used to determine the independent risk factors for new lower limb DVT.Results Among the 183 patients,54(29.5%)developed new onset lower limb DVT postoperatively.There were 2 cases of cen⁃tral thrombosis,6 cases of mixed thrombosis,and 46 cases of peripheral thrombosis.No case of pulmonary embolism was found.No significant differences were observed between the DVT and non-DVT groups in terms of BMI,comorbid medical conditions,laterality of fracture,AO classification of fracture,proportion of patients with blood type O,time from fracture to surgery,anes⁃thesia method,intraoperative blood loss,preoperative lipid profile,coagulation function,and HDL-C and ATPP levels on the second postoperative day(P>0.05).However,statistically significant differences were found between the two groups in gender,age,cause of injury,operative duration,intraoperative infusion volume,perioperative blood transfusion volume,as well as TC,TG,LDL-C,D-dimer,and FIB levels on the second postoperative day(P<0.05).Multivariate Logistic regression analysis re⁃vealed that age,intraoperative infusion volume,perioperative blood transfusion volume,and D-dimer levels on the second post⁃operative day were significantly associated with the development of new onset lower limb DVT after PFNA internal fixation for femoral intertrochanteric fractures.Conclusion The incidence of new onset lower limb DVT after PFNA internal fixation for femoral intertrochanteric fractures is relatively high,but peripheral thrombosis is the predominant type.Advanced age,large intra⁃operative infusion volume,high perioperative blood transfusion volume,and elevated postoperative D-dimer levels are more like⁃ly to contribute to the development of DVT of the lower limbs.