老年股骨颈骨折围术期下肢深静脉血栓形成危险因素分析

Risk factors of perioperative deep venous thrombosis of lower extremities in elderly patients with femoral neck fracture

目的探讨老年股骨颈骨折围术期下肢深静脉血栓形成(deep venous thrombosis,DVT)的发生率及其危险因素。方法回顾分析2012年8月—2020年11月收治且符合选择标准的4109例老年股骨颈骨折患者临床资料。其中男1137例,女2972例;年龄65~101岁,平均77.0岁。骨折至入院时间1~360 h,平均35.2 h。手术采用半髋关节置换术1858例、全髋关节置换术1617例、内固定手术634例。术前年龄校正查尔森合并症指数(aCCI)为4(3,5)。围术期发生DVT 857例(20.9%)。对发生与未发生围术期DVT患者的年龄、性别、身体质量指数、骨折侧别、骨折至入院时间、手术方式、麻醉方式、是否输血、入院后血压、术前aCCI等变量进行单因素分析,并进一步采用logistic回归分析筛选老年股骨颈骨折围术期发生DVT的危险因素。结果单因素分析示,两组年龄、性别、骨折至入院时间、手术方式及术前aCCI比较差异有统计学意义(P<0.05);进一步行logistic回归分析示,年龄>75岁、女性患者、骨折至入院时间>24 h以及术前aCCI>5是老年股骨颈骨折围术期发生DVT的危险因素(P<0.05)。结论老年股骨颈骨折患者围术期有较高的DVT发生率,高龄、女性、骨折时间较长及合并症较多的患者需要特别注意预防。

Objective To investigate the incidence of perioperative deep venous thrombosis(DVT)of lower extremities and its risk factors in elderly patients with femoral neck fracture.Methods The clinical data of 4109 elderly patients with femoral neck fracture admitted between August 2012 and November 2020 and met the selection criteria were retrospectively analyzed.Among them,there were 1137 males and 2972 females;their ages ranged from 65 to 101 years,with an average of 77.0 years.The time from fracture to admission ranged from 1 to 360 hours,with an average of 35.2 hours.There were 1858 cases of hemiarthroplasty,1617 cases of total hip arthroplasty,and 634 cases of internal fixation surgery.The preoperative age-adjusted Charlson comorbidity index(aCCI)was 4(3,5).Perioperative DVT occurred in 857 cases(20.9%).Univariate analysis was performed on age,gender,body mass index,fracture side,time from fracture to admission,operation type,anesthesia type,blood transfusion,blood pressure after admission,and preoperative aCCI in patients with and without perioperative DVT,and logistic regression analysis was used to screen the risk factors of perioperative DVT in elderly patients with femoral neck fracture.Results Univariate analysis showed that there were significant differences in age,gender,time from fracture to admission,operation type,and preoperative aCCI between the two groups(P<0.05).Further logistic regression analysis showed that age>75 years,female patients,time from fracture to admission>24 hours,and preoperative aCCI>5 were risk factors for perioperative DVT(P<0.05).Conclusion Elderly patients with femoral neck fracture have a higher incidence of perioperative DVT.The advanced aged and female patients,patients with longer fracture time and more comorbidities need to pay special attention to the prevention of perioperative DVT to minimize the occurrence of DVT during femoral neck fractures.