| 张秀珍,翟延荣,李明丽,等.小腿外伤后创面感染病人并发下肢深静脉血栓的危险因素分析与预测模型构建.骨科,2025,16(6): 510-514. |
| 小腿外伤后创面感染病人并发下肢深静脉血栓的危险因素分析与预测模型构建 |
| Risk factors analysis and predictive model construction of deep vein thrombosis in patients with lower limb wound infections following traumatic injury |
| 投稿时间：2025-07-23 |
| DOI：10.3969/j.issn.1674-8573.2025.06.006 |
| 中文关键词: 静脉血栓形成 下肢 危险因素 血肿 年龄 血红蛋白 |
| 英文关键词: Venous thrombosis Lower extremity Risk factors Hematoma Age Hemoglobin |
| 基金项目:江苏省苏州市科技计划项目（SYW2024059）；苏州市吴中区科技计划重点项目（WZYW2022004）；苏州市吴中人民医院院内项目（2022yjky08） |
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| 中文摘要: |
| 目的 探讨小腿外伤后创面感染病人并发下肢深静脉血栓（deep venous thrombosus，DVT）的危险因素并构建预测模型。方法 回顾性分析我院创面修复科2022年5月至2025年5月期间出院的165例小腿外伤后创面感染病人的临床资料，根据入院时是否发生下肢DVT分成DVT组和非DVT组，构建多因素Logistic回归模型，筛选影响小腿外伤后创面感染病人并发下肢DVT的独立危险因素，并绘制受试者工作特征（ROC）曲线分析模型的预测价值。结果 本研究纳入的165例小腿外伤后创面感染病人入院时下肢DVT发生率为14.55%（24/165），共计30条血栓，其中86.67%（26/30）为下肢远端DVT。创面细菌检出率为41.82%，以革兰氏阳性菌为主，检出率最高的为金黄色葡萄球菌，其次为阴沟肠杆菌。单因素分析提示DVT组的年龄、D-二聚体、合并高血压、创面合并血肿、创面细菌检出均高于非DVT组，而血红蛋白则低于非DVT组，差异有统计学意义（P＜0.05）；多因素回归分析显示年龄[OR=1.054，95% CI（1.018，1.092），P=0.003]、创面合并血肿[OR=8.853，95% CI（2.466，31.783），P=0.001]、血红蛋白[OR=0.971，95% CI（0.944，1.000），P=0.047]是小腿外伤后创面感染病人并发下肢DVT的独立危险因素。根据风险因素构建预测模型，该模型ROC曲线下面积为0.816[95% CI（0.724，0.907），P＜0.001]，灵敏度为87.50%，特异度为63.83%，约登指数为0.513。结论 年龄、创面合并血肿、血红蛋白与小腿外伤后创面感染病人入院时并发下肢DVT密切相关，构建的预测模型具有较好的预测性能，具有一定的临床应用价值。 |
| 英文摘要: |
| Objective To explore risk factors and develop a predictive model for deep vein thrombosis (DVT) in patients with post-traumatic lower limb wound infection. Methods A retrospective analysis was conducted on the clinical data of 165 patients with wound infections after lower limb trauma who were discharged from the Wound Healing Department of our hospital from May 2022 to May 2025. Based on whether DVT occurred upon admission, the patients were divided into DVT group and non-DVT group. A multivariate Logistic regression model was constructed to identify independent risk factors for the development of lower limb DVT in patients with wound infections after lower limb trauma. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of the model. Results In this study, among the 165 patients with wound infections after lower limb trauma, the incidence of lower limb DVT upon admission was 14.55% (24/165), totaling 30 thrombi, with 86.67% (26/30) were distal lower limb DVT. The wound bacterial detection rate was 41.82%, predominantly Gram-positive bacteria, with Staphylococcus aureus being the most frequently detected, followed by Enterobacter cloacae. Univariate analysis revealed that the DVT group exhibited significantly older age, higher D-dimer levels, and greater comorbid hypertension, wound-associated hematoma, and bacterial detection rates than the non-DVT group, while hemoglobin levels were lower in the DVT group (all P＜0.05). Multivariate regression analysis identified age [OR=1.054, 95% CI (1.018, 1.092), P=0.003], wound-associated hematoma [OR=8.853, 95% CI (2.466, 31.783), P=0.001], and hemoglobin [OR=0.971, 95% CI (0.944, 1.000), P=0.047] as independent risk factors for lower limb DVT in patients with wound infections after lower limb trauma. A predictive model based on these risk factors demonstrated an ROC curve area of 0.816 [95% CI (0.724, 0.907), P＜0.001], with a sensitivity of 87.50%, specificity of 63.83%, and a Youden index of 0.513. Conclusion Age, wound-associated hematoma, and hemoglobin were significantly associated with concurrent DVT in patients with lower limb wound infections following traumatic injury. The constructed prediction model demonstrated good discriminatory performance and potential clinical utility. |
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