膝关节周围骨折患者术前下肢深静脉血栓形成的危险因素分析  

Analysis of risk factors for preoperative lower extremity deep vein thrombosis in patients with knee periphery fractures

作　　者：马骥 许国强 高化[1] 白晓冬[1] 刘振宇[1] 王刚[1] 陈文韬[1] 赵亮[1] 李亚东[1] 王宝军[1] MA Ji;XU Guoqiang;GAO Hua;BAI Xiaodong;LIU Zhenyu;WANG Gang;CHEN Wentao;ZHAO Liang;LI Yadong;WANG Baojun(Department of Orthopedics,Bejing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《中国骨与关节损伤杂志》2023年第10期1033-1037,共5页Chinese Journal of Bone and Joint Injury

基　　金：国家自然科学基金青年科学基金项目(81701203);北京市属医院科研培育计划(PX2021004)。

摘　　要：目的探讨膝关节周围骨折患者术前下肢深静脉血栓形成的相关危险因素,观察术前膝关节腔积液量是否与下肢深静脉血栓形成存在相关性。方法回顾性分析自2018-09—2021-03诊治的150例膝关节周围骨折,根据术前双下肢深静脉彩色多普勒超声检查结果,35例血栓形成(血栓组),115例无血栓形成(无血栓组)。采用单因素分析术前下肢深静脉血栓形成的相关因素,采用多因素Logistic回归分析筛选独立危险因素,观察骨折后膝关节腔内积液量是否增加术前下肢深静脉血栓形成发生的风险。结果纳入的150例中35例术前出现血栓,术前血栓发生率为23.3%,其中4例近端血栓,28例远端血栓,3例混合血栓。血栓组与无血栓组在体质量指数、骨折部位、骨折侧别、入院时血红蛋白、红细胞比容、纤维蛋白原方面差异无统计学意义(P>0.05);两组间性别、年龄、术前ASA分级、手术等待时间、入院后24 h的D-二聚体、术前24 h的D-二聚体、膝关节腔积液量差异有统计学意义(P<0.05)。将单因素分析后差异有统计学意义的项目纳入多因素Logistic回归分析,结果显示性别、术前24 h的D-二聚体、膝关节腔积液量是膝关节周围骨折患者术前下肢深静脉血栓形成的独立危险因素。结论膝关节周围骨折患者术前容易出现下肢深静脉血栓形成,特别是对于术前D-二聚体升高、膝关节腔内积液量较多的女性患者,临床医师应予以高度重视,需要进行早期预防,并且积极抗凝治疗。Objective To investigate the risk factors of preoperative lower extremity deep vein thrombosis in patients with knee periphery fractures,and to observe whether there was a correlation between the volume of joint cavity effusion and the deep vein thrombosis in the lower limbs.Methods A retrospective analysis was performed on 150 cases of knee periphery fractures diagnosed and treated from September 2018 to March 2021.According to the results of preoperative deep vein color Doppler ultrasound examination of both lower limbs,35 cases had thrombosis(thrombus group)and 115 cases had no thrombosis(nonthrombus group).Univariate analysis was used to analyze the related factors of lower extremity deep vein thrombosis before surgery,and multivariate Logistic regression analysis was used to select independent risk factors to observe whether the volume of joint cavity effusion after fracture increased the risk of lower extremity deep vein thrombosis before surgery.ResultsAmong the 150 cases included,35 cases had preoperative thrombosis,the incidence of thrombus before operation was 23.3%,including 4 cases of proximal thrombus,28 cases of distal thrombus,and 3 cases of mixed thrombus.There were no significant differences in body mass index,fracture site,fracture side,hemoglobin,erythrocyte volume and fibrinogen at admission between the thrombus group and the non-thrombus group(P>0.05).There were significant differences between the two groups in gender,age,preoperative ASA grading,waiting time for surgery,D-dimer 24 h after admission,D-dimer 24 h before surgery,and the volume of joint cavity effusion(P<0.05).The items with statistically significant differences after univariate analysis were included in multivariate Logistic regression analysis,and the results showed that gender,D-dimer level 24 h before surgery,and the volume of joint cavity effusion were independent risk factors for preoperative deep venous thrombosis of lower limbs in patients with knee periphery fracture.Conclusion Patients with knee periphery fracture are

关 键 词：膝关节周围骨折 下肢深静脉血栓形成 膝关节腔积液量 相关因素分析 独立危险因素 

分 类 号：R687.3[医药卫生—骨科学]