【摘要】 目的探讨中青年髋部骨折患者围术期并发下肢深静脉血栓 (deep venous thrombosis,DVT) 的发生率及危险因素分析。方法回顾性分析 2015 年 9 月至 2019 年 12 月我院创伤骨科收治的 186 例中青年髋部骨折患者临床资料,其中男 116 例,女 70 例;年龄 18～60 岁,平均 (47.96±11.35) 岁;股骨颈骨折117 例,转子间骨折 44 例,转子下骨折 25 例,其中合并其它部位骨折 31 例。入院、术前 3 天及术后 3 天每天行双下肢深静脉检查。收集记录患者的一般资料,包括年龄、性别、骨折部位、受伤原因、是否合并其它部位骨折、是否合并内科疾病 (原发性高血压、2 型糖尿病、冠心病)、ASA 分级、术中失血量、术中输血量、手术时间、血清学指标、受伤至入院时间。结果本组中 77 例发生下肢 DVT,发病率为 41.40%,其中男 52 例 (67.53%),女 25 例 (32.47%)。11 例 (14.29%) 为混合型血栓,4 例 (5.19%) 为近端血栓,66 例(80.52%) 为远端血栓。合并其它部位骨折 (OR=2.534,95% CI 1.045～6.145,P=0.040)、受伤至入院时间 (OR=1.181,95% CI 1.049～1.330,P=0.006)、术后 1 天 D-二聚体 (OR=1.052,95% CI 1.007～1.098,P=0.023) 是围术期 DVT 形成的独立危险因素。结论中青年髋部骨折患者围术期下肢 DVT 形成的风险性高,当患者延迟入院、合并多发伤时因尽早行双下肢超声检查,并动态监测 D-二聚体,及时发现下肢 DVT,减少患者发生肺栓塞的风险,提高患者的生活质量。更多还原

【Abstract】 Objective To explore the incidence and risk factors of perioperative deep vein thrombosis of lower extremities in the young and middle-aged hip fracture patients.Methods A retrospective study of the data of186 young and middle-aged hip fracture patients,admitted to the Department of Traumatology and Orthopedics of Xi’an Honghui Hospital from September 2015 to December 2019,was conducted.There were 116 males and 70 females aged 18-60 years (47.96±11.35).There were 117 cases of femoral neck fracture,44 cases of intertrochanteric fracture,25 cases of subtrochanteric fracture,among whom 31 cases were combined with other fractures.Deep vein examinations of both lower extremities were performed every day on admission,3 days before surgery and 3 days after surgery.General information including age,gender,fracture site,cause of injury,combined fractures,combined medical diseases (primary hypertension,type 2 diabetes,coronary heart disease),ASA classification,intraoperative blood loss,intraoperative blood transfusion,operation time,serological indicators and time from injury to hospital admission were collected and recorded.Results DVT was noted in 77 patients with an incidence rate of 41.40%,including 52 males (67.53%) and 25 females (32.47%).Mixed thrombus was observed in 11 cases (14.29%),proximal thrombus in 4 cases (5.19%),and distal thrombus in 66 cases (80.52%).Combined fractures (OR=2.534,95% CI 1.045-6.145,P=0.040),time from injury to hospital admission (OR=1.181,95% CI 1.049-1.330,P=0.006) and D-Dimer 1 day after operation (OR=1.052,95% CI 1.007-1.098,P=0.023) were independent risk factors for DVT perioperatively.Conclusions Young and middle-aged patients with hip fracture have a higher risk of lower extremity DVT perioperatively.Early ultrasound examination of both lower extremities and dynamical monitor of D-dimer are recommended to reduce the risk of pulmonary embolism when the patient is delayed in hospitalization or complicated with multiple injuries.更多还原