股骨转子间骨折患者围术期深静脉血栓发生及危险因素分析  

Analysis of prevalence and risk factors of perioperative deep venous thrombosis in patients with intertrochanteric femur fractures

作　　者：李杰 王谦[2] 路遥[2] 李忠[2] 杨娜[2] 田丁[2] 林华 张堃[2] Li Jie;Wang Qian;Lu Yao;Li Zhong;Yang Na;Tian Ding;Lin Hua;Zhang Kun(Postgraduate Depratment of Yan'an University,Yan'an University,Yan'an 716000,China;Department of Orthopedic Surgery,Honghui Hospital,Xi'an Jiaotong University Medical College,Xi'an 710054,China)

机构地区：[1]延安大学研究生处,716000 [2]西安交通大学医学院附属红会医院创伤骨科,710054

出　　处：《中华创伤杂志》2020年第6期536-543,共8页Chinese Journal of Trauma

基　　金：陕西省重点项目(2017ZDXM-SF-009)。

摘　　要：目的探讨股骨转子间骨折患者围术期深静脉血栓(DVT)的发生规律及危险因素。方法采用回顾性病例对照研究分析2014年6月—2018年9月西安交通大学医学院附属红会医院收治的485例股骨转子间骨折患者临床资料,其中男196例,女289例;年龄16~102岁,平均74.6岁。根据术前和术后下肢静脉彩超结果将所有患者分为术前DVT组、非DVT组和术后DVT组、非DVT组。统计患者术前、术后DVT发生率及术前到术后变化规律。评估术前、术后DVT发生相关危险因素,包括患者一般资料、手术时间、术中失血量、术中输液量、手术方式、术中输血量、血清学指标等。先采用单因素分析筛选危险因素,再采用多因素Logistic回归分析确定主要的独立危险因素。结果术前DVT发生率为36.5%,术后DVT发生率为57.1%(P<0.05)。术前单侧DVT发生率为30.5%,术后单侧DVT发生率为37.5%(P<0.05)。术前双侧肢体DVT发生率为6.0%,术后双侧肢体DVT发生率为20.0%(P<0.05)。术前近端、混合、远端DVT发生率分别为2.8%、6.7%、90.4%;术后近端、混合、远端DVT发生率分别为2.2%、4.7%、93.1%。术前到术后血栓无变化293例(60.4%),加重164例(33.8%),减轻28例(5.8%)。单因素结果分析显示,术前DVT组与非DVT组在骨折侧别、美国麻醉医师协会(ASA)评分、受伤至入院时间、纤维蛋白原、骨折AO分型、合并内科疾病、合并多种内科疾病等方面差异均无统计学意义(P>0.05),两组在性别、年龄、受伤至手术时间、血红蛋白、红细胞压积、D-二聚体、既往有静脉血栓栓塞症(VTE)病史、合并其他部位损伤等方面差异有统计学意义(P<0.05);术后DVT组与术后非DVT组在年龄、骨折侧别、手术时间、术中失血量、术中输液量、ASA评分、受伤至入院时间、术中输血量、骨折AO分型、合并内科疾病、合并多种内科疾病、合并其他部位损伤等方面差异均无统计学意义(P>0.05),而两�Objective To explore the incidence and risk factors of perioperative deep vein thrombosis(DVT)in patients with intertrochanteric femur fractures.Methods A retrospective case-control study was used to analyze the clinical data of 485 patients with intertrochanteric femur fracture treated from June 2014 to September 2018 in Honghui Hospital affiliated to Xi'an Jiaotong University Medical College.There were 196 males and 289 females,aged 16 to 102 years,with an average of 74.6 years.All patients were divided into preoperative DVT group,non-DVT group,and postoperative DVT group and non-DVT group according to the results of preoperative and postoperative lower limb vein color Doppler ultrasound.The preoperative and postoperative incidence of DVT was counted and the preoperative to postoperative changes of the DVT was detected.The risk factors related to the preoperative and postoperative DVT were evaluated,including general patient information,operation time,intraoperative blood loss,intraoperative infusion volume,Surgical methods,intraoperative blood transfusion,serological indicators,etc.Single factor analysis was used to screen for risk factors,and then multivariate logistic regression analysis was used to determine the main independent risk factors.Results The incidence of DVT before and after operation was 36.5%,57.1%,respectively(P<0.05).The incidence of unilateral DVT before and after operation was 30.5%,37.1%,respectively(P<0.05).The incidence of bilateral DVT before and after operation was 6.0%,20.0%(P<0.05).The preoperative rates of proximal,mixed,and distal DVT were 2.8%,6.8%and 90.4%,respectively.The postoperative rates of proximal,mixed,and distal DVT were 2.2%,4.7%and 93.1%,respectively.There were 293 patients(60.4%)showing no change in thrombosis,164 patients(33.8%)aggravation,and 28 patients(5.8%)reduction.Univariate analysis showed the preoperative DVT group and non-DVT group had significant differences in gender,age,time from injury to operation,hemoglobin,hematocrit,D-dimer,previous history of venou

关 键 词：股骨骨折 静脉血栓形成 危险因素 发病率 

分 类 号：R687.3[医药卫生—骨科学]