文章摘要
李树灏,张堃,冯东旭,衡立松,蔡枭,田丁,杨娜,张军,朱养均.髋部骨折24小时内及延迟入院的下肢深静脉血栓发生情况分析.骨科,2019,10(4):307-313
髋部骨折24小时内及延迟入院的下肢深静脉血栓发生情况分析
Occurrence of deep venous thrombosis in lower extremities within 24 h after hip fracture and change in incidence of thrombosis after delayed admission
投稿时间:2019-04-18  
DOI:10.3969/j.issn.1674-8573.2019.04.010
中文关键词: 髋部骨折  静脉血栓形成  危险因素  延迟入院
英文关键词: Hip fracture  Venous thrombosis  Risk factors  Delayed admission
基金项目:陕西省重点研发计划项目(2017ZDXM-SF-009)
作者单位E-mail
李树灏 西安医学院西安 710068西安交通大学医学院附属红会医院创伤骨科西安 710054  
张堃 西安交通大学医学院附属红会医院创伤骨科西安 710054 hhyyzk@126.com 
冯东旭 西安交通大学医学院附属红会医院创伤骨科西安 710054  
衡立松 西安交通大学医学院附属红会医院创伤骨科西安 710054  
蔡枭 西安交通大学医学院附属红会医院创伤骨科西安 710054  
田丁 西安交通大学医学院附属红会医院创伤骨科西安 710054  
杨娜 西安交通大学医学院附属红会医院创伤骨科西安 710054  
张军 西安交通大学医学院附属红会医院创伤骨科西安 710054  
朱养均 西安交通大学医学院附属红会医院创伤骨科西安 710054  
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中文摘要:
      目的 探讨髋部骨折病人骨折后24 h内下肢深静脉血栓形成(deep vein thrombosis, DVT)的发生率及危险因素,并对超过24 h住院病人血栓发生率的变化进行分析。方法 回顾性分析西安交通大学医学院附属红会医院2014年10月至2018年3月收治的1 183例髋部骨折病人资料,根据受伤时间至入院时间进行分组。分析24 h内住院的374例髋部骨折病人资料,根据入院时下肢静脉彩超结果分为DVT组和非DVT组,对两组病人的年龄、性别、身体质量指数(body mass index, BMI)、骨折类型、美国麻醉医师协会(America Society of Anesthesiologists, ASA)分级、入院时的实验室检查、是否多发伤、是否合并内科疾病等可能危险因素进行单因素分析;采用多因素Logistic回归分析确定其独立危险因素;对超过24 h住院的病人进行DVT发生率的变化情况分析。结果 在髋部骨折后24 h内入院的374例髋部骨折病人中,未发生DVT有292例,发生DVT有82例,血栓发生率为21.93%(82/374)。分析DVT组和非DVT组之间的数据,年龄(P=0.005)、骨折部位(P<0.001)、入院时血红蛋白(P=0.002)、入院时红细胞压积(P=0.004)之间的差异有统计学意义;多因素Logistic回归分析结果显示:年龄、骨折部位是髋部骨折24 h内形成DVT的独立危险因素。粗隆间骨折[P=0.002,OR=2.510,95%CI:(1.397,4.510)]和粗隆下骨折[P=0.023,OR=4.798,95%CI:(1.237,18.605)]发生DVT的风险分别是股骨颈骨折发生DVT风险的2.51倍、4.80倍。45~59岁、60~75岁、≥75岁年龄段病人分别是<45岁病人发生DVT风险的3.12、3.20、6.45倍。24 h内入院的病人DVT发生率最低,延迟住院后DVT发生率逐渐升高,在受伤后8~14 d入院的病人DVT发生率最高,达到48.86%。结论 髋部骨折后24 h内就会发生DVT,DVT的类型以远端血栓为主,也会发生近端血栓,年龄≥75岁、股骨粗隆下骨折的病人发生DVT的风险最高。髋部骨折后,随着入院时间的推迟,DVT的发生率逐渐升高。入院后应当第一时间对DVT进行诊断和预防,防止发生致命性肺栓塞。
英文摘要:
      Objective To investigate the incidence and risk factors of deep vein thrombosis (DVT) in patients with hip fracture within 24 h after fracture, and to analyze the changes of thrombosis rate in hospitalized patients over 24 h. Methods A retrospective analysis on 1 183 patients with hip fractures admitted to the Honghui Hospital Affiliated to Xi'an Jiaotong University from October 2014 to March 2018 was conducted according to the number of days from the time of admission. Three hundred and seventy-four patients with hip fractures who were hospitalized within 24 h were analyzed. According to the results of color Doppler ultrasonography of lower extremity veins at admission, the patients were divided into two groups: DVT group and non-DVT group. Univariate analysis of possible risk factors for age, gender, body mass index (BMI), fracture type, America Society of Anesthesiologists (ASA) classification, laboratory tests at admission, multiple injuries, and medical complications was performed in both groups. Multivariate Logistic regression analysis was used to determine independent risk factors. Patients with hospitalization for more than 24 h were analyzed for changes in DVT incidence. Results Among 374 patients admitted to hospital within 24 h after hip fracture, there were 292 cases of non-DVT and 82 cases of DVT. The incidence of thrombosis was 21.93% (82/374). The data between DVT group and non-DVT group were analyzed. There were significant differences in age (P=0.005), fracture site (P<0.001), hemoglobin at admission (P=0.002) and hematocrit at admission (P=0.004). Multivariate logistic regression analysis showed that age and fracture site were risk factors for DVT formation within 24 h after hip fracture. The risk of DVT in femoral intertrochanteric [P=0.002, OR=2.510, 95%CI: (1.397, 4.510)] and subtrochanteric fractures [P=0.023, OR=4.798, 95%CI: (1.237, 18.605)] was 2.51 and 4.80 times higher than that in femoral neck fractures, respectively. 45-59, 60-75, ≥75 years old patients had 3.12, 3.20, 6.45 times of DVT risk in patients <45 years old. Patients admitted to hospital within 24 h had the lowest incidence of DVT, and the incidence of DVT gradually increased after delayed hospitalization. The incidence of DVT was the highest in patients admitted to hospital from 8-14 days after injury, reaching 48.86%. Conclusion DVT occurs within 24 h after hip fracture. The type of DVT is mainly distal thrombus, and proximal thrombus can occur. The patients with age of ≥75 years old and femoral subtrochanteric fracture have the highest risk of DVT. After the hip fracture, the incidence of DVT gradually increased with the delay of admission. DVT should be diagnosed and prevented as soon as possible after admission to prevent fatal pulmonary embolism.
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