超声对下肢骨折后深静脉血栓形成的检测及相关因素的评价  

Clinical study on lower extremity deep vein thrombosis following lower limb fracture by ultrasound

作　　者：夏爱君[1] 郭方明[1] 赵燕[1] 

机构地区：[1]烟台市烟台山医院超声科,山东省264001

出　　处：《中华临床医师杂志（电子版）》2009年第6期49-52,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：国家"十五"科技攻关资助协作项目(2001BA703B15)

摘　　要：目的应用彩色多普勒超声观察下肢骨折后下肢深静脉血栓的形成,评价血栓形成前后的相关危险因素。方法375例下肢骨折患者,应用彩色多普勒超声于患者手术前后观察下肢深静脉各段内径,血栓累及部位、范围及血栓的特殊表现,观察管腔内血流是否充盈、充盈的血流走行是否迂曲。分析性别、年龄、体重、骨折类型及部位对血栓产生的影响。随访6个月观察肺动脉栓塞的发生。结果检出静脉血栓患者114例,超声检出率为30.4%,手术前后检出率差异无统计学意义。小腿内静脉易发生血栓;检出率随年龄增高而增加;无性别差异;膝部骨折患者检出率最高,足踝部骨折患者检出率最低。多元Logistic回归分析显示外伤时间、骨折部位、骨折类型及血D-二聚体是下肢静脉血栓发生的主要相关因素。胫后静脉及以上各段静脉血栓、血栓粗大及血栓浮动是引发肺动脉血栓栓塞症的高危因素。结论下肢骨折易诱发深静脉血栓形成,彩色多普勒超声可明确下肢静脉血栓的解剖部位及血流特征,预测肺动脉栓塞。Objective To study incidence rate of lower extremity deep vein thrombosis（DVT） after lower limb fracture by color doppler ultrasound and to evaluate the risk factors for thromboembolism. Methods Vein lumen inner diameter, position and range involved thrombus, luminal blood flow patency were observed preoperative and postoperative in 375 cases of lower limb fracture, and PTE occurrences were detected following in 6 months. Results 114 of 375 cases were observed DVT, incidence was 30. 4%. No differences were found between before and after operation. DVT incidence was increased by following position of fracture ： pelvis, thighbone, shankbone, spine and feet. Age, time, open fractures and D dimer were main risk factors for DVT incidence by logistic analysis. Irregular low-medial echo and floating thrombosis especially in big vessels were markers for the risk of pulmonary thromboembolism. Conclusions Color doppler ultrasound can definite vessel anatomy and blood flow charateristics of DVT and prognosticate the following pulmonary thromboembolism.

关 键 词：静脉血栓形成 骨折 肺栓塞 超声检查 

分 类 号：R445.1[医药卫生—影像医学与核医学] R683[医药卫生—诊断学] R654.3[医药卫生—临床医学]