不同部位创伤骨折患者D-二聚体水平的临床意义  

作　　者：李恒[1] 张凯[1] 黄津[1] 陆金红[1] 赵曙光[1] 王毅[1] 

机构地区：[1]天津医院检验科,300211

出　　处：《继续医学教育》2012年第3期38-40,共3页Continuing Medical Education

摘　　要：目的:通过分析不同部位骨折的创伤患者血浆D-二聚体水平,及其与深静脉栓塞发生率的关系,为临床预防及治疗血栓性疾病提供依据。方法:选择2010年5月～2011年8月因骨折至我院骨科入院治疗的患者479例,根据不同骨折部位将其分为以下6组:胫腓骨骨折、股骨骨折、足骨骨折、上肢骨骨折、脊柱骨折和多发骨折。患者于入院第2天清晨空腹抽静脉血测定血清D-二聚体浓度。以下肢血管彩色多普勒超声检查判断有无DVT的发生。结果:不同部位骨折患者血浆D-二聚体水平有显著差异(F=12.90,P<0.01),由高到低依次为多发伤、股骨、胫腓骨、脊柱、足骨和上肢骨。479例患者中发生DVT 45例,发生率为9.4%。其中胫腓骨骨折组9例(7.8%,9/115);股骨骨折组28例(17.0%,28/165);足骨骨折组1例(1.4%,1/71);多发骨折组4例(9.3%,4/43);上肢骨骨折组1例(2.4%,1/42);脊柱骨折组2例(4.7%,2/43),各组间差异有显著性(P<0.01)。D-二聚体水平与DVT发生率间有显著的正相关性(r=0.886,P=0.019)。结论:骨折部位及损伤程度与D-二聚体水平有密切的联系,且D-二聚体浓度和DVT的发生率有很强的相关性。对于DVT发生率较高部位骨折的患者,在D-二聚体水平升高时,应高度警惕DVT的出现,采取积极的预防措施,以防止DVT的形成。Objective: To analyze the relationship between the level of plasma D-dimer and the incidence rate of deep vein thrombosis(DVT) in orthopeadic trauma patients with fractures in different locations.Methods: Patients with fresh four extremities and vertebrae fracture form May 2010 to August 2011 were involved in this study and were divided into 6 groups based on the locations of fracture.D-dimer assays were performed within 48 hours of admission.Each patient had Doppler ultrasound examinations as the epidemiology diagnostic criterion for DVT.Results: There were 479 patients,with the mean age of 47.7 years(ranged 16~85).The difference of D-dimer levels was significant between the groups(F=12.90,P<0.01),the concentrations of D-dimer in different patients from higher to lower were patients with multiple fractures,femoral fractures,tibia and fibula fractures,vertebrae fractures,foot fractures,upper limb fractures.DVT was found in 45 cases(9.4%),of which 9 cases occurred in patients with tibia and fibula fractures(9/115,7.8%),28 in patients with femoral fractures(28/165,17.0%),1 in patients with foot fractures(1/71,1.4%),4 in patients with multiple fractures(4/43,9.3%),1 in patients with upper limb fractures(1/42,2.4%),2 in patients with vertebrae fractures(2/43,4.7%).There was notable positive correlation between the level of D-dimer and the incidence rate of DVT(r=0.886,P=0.019).Conclusion: For trauma fracture patients,The level of D-dimer was associated with the locations of fracture,and there was notable positive correlation between the level of D-dimer and the incidence rate of DVT.Therefore,the incidence of DVT has relationships with fracture site and level of D-dimer,the surgeons should recognize the importance to prevent DVT and PE in those patients.

关 键 词：创伤骨折 D-二聚体 静脉血栓形成 

分 类 号：R68[医药卫生—骨科学]