上肢创伤骨折围手术期并发深静脉血栓的诊治体会

目的探讨上肢创伤骨折并发深静脉血栓(DVT)的诊断和治疗方法。方法对16例上肢创伤围手术期合并DVT患者的诊断及治疗情况进行回顾性分析。诊断方法有上肢血管彩色多普勒超声、多层螺旋CT血管成像(CTA)、上肢动脉造影以及血浆D-二聚体检测,治疗方法以尿激酶溶栓联合低分子肝素钙抗凝为主。结果 16例患者中血清D-二聚体水平增高14例,经上肢血管彩色多普勒超声检查诊断8例,经CTA检查发现3例,经上肢血管造影诊断5例。6例术前并发DVT患者经治疗后5例血栓消失,行骨折切开复位术,术后痊愈出院;10例术后并发DVT患者经治疗后8例血栓消失,2例在住院期间并发肺栓塞,1例经积极抢救成功,1例患者抢救无效死亡。结论彩色多普勒超声检查是诊断上肢创伤骨折合并DVT的首选方法,一旦确诊应早期溶栓及抗凝治疗。

Diagnosis and treatment of upper limb trauma fracture complicated with deep vein thrombosis during preopera- tive period

Objective To explore the diagnosis and treatment of upper limb trauma fracture complicated with deep vein thrombosis （DVT） during preoperative period. Methods The data of 16 patients with upper limb trauma fractures complicated with DVT was analyzed retrospectively. The methods of diagnosis included color Doppler uhrasonography, multi slice CT angiography （ CTA）, artery and vein visual- ization of upper limbs, and D-dimer detection. The treatment was majm＇ed in thromboiysis by urokinase and anticoagulation by low molecular heparin. Results There were 14 patients with increased levels of D-direct,8 patients diagnosed by color Doppler uhrasonography,3 patients diagnosed by CTA and 5 by artery and vein visualization. The DVT of 5 patients before operation were disappeared after treatment and cured. Among the 10 patients received operation,8 cases were succeeded and 2 cases complicated with pulmonary embolism, and 1 case was died. Conclusion The color Doppler uhrasonography is the first priority for diagnosis of upper limb trauma fracture complicated with DVT. The patients should be discovered in time and arranged thrombolysis and anticoagulation in early time.