股骨干骨折患者深静脉血栓形成的时间分布及D-二聚体的诊断价值

目的:探讨股骨干骨折患者下肢深静脉血栓形成(DVT)发生时间规律及血浆D一二聚体浓度对其诊断价值.方法:选取138例于承德医学院附属医院创伤骨科采用手术治疗的股骨干骨折患者,分别于伤后第1天、术前1d、术后1d、术后3d、术后5d测定血浆D一二聚体浓度,并于伤后第1天、伤后第3天、伤后第5天,伤后超过5d及术后第2天、术后第5天、术后第7天、术后第14天行下肢静脉彩超检查.结果:血栓组共纳入23患者例患者,其中8例(5.80%)发生于伤后1~3d,8(5.80%)例发生于术后第2天.患者创伤后D-二聚体水平均值高于正常值,术前1d血栓组D-二聚体水平明显高于非血栓组,差异有统计学意义(P<0.05);当D-二聚体临界值为2.31ug/mL时,敏感性为0.631,特异性为0.509当D-二聚体临界值为4.63ug/mL时,敏感性为0.481,特异性为0.807.结论:①患者血栓发生的高峰时间是伤后第3天和术后第1天.②D-二聚体对创伤后下肢静脉血栓的诊断具有一定的诊断价值,术前1d以4.63ug/mL,作为临界值较为合适.③D-二聚体变化趋势与血栓发生的高峰趋势相近.

Deep Vein Thrombosis and D-dimer in Patients with Femoral Shaft Fracture

Objective:To investigate the factors associated with the incidence of deep vein thrombosis ( DVT) and D-dimer in the patients with femoral shaft fracture. Methods:Enrolled in the study were 138 pa-tients with femoral shaft fracture who had been treated from June 2014 to December 2015. They were rese-anched according to the presence or absence of DVT. The D-dimmer levels were examined for all the cases on the first day after admission,the day before surgery,the 1st, 3rd, and 5th day after surgery. Results:In this cohort, DVT occurred in 23 cases. 8 cases(5.80%)occurred in 1 to 3 days after injury, and 8 (5.80%) cases were born at postoperative day second. The level of posttraumatic D-dimer was higher than the normal value. In 1 day before surgery, the D-dimer in thrombus group was significantly higher than non thrombus group, the difference was statistically significant (P<0.05), and third days after the surgery D-dimer level decreased gradually. When the D-dimer critical value was 2.31ug/mL, its sensitivity was 0.631 and its specificity 0.509 in the diagnosis of DVT;when the D-dimer critical value was 4.63ug/mL, the sensitivity was 0.481 and the specificity was 0.807 in the diagnosis of DVT. Conclusions:Perioperative DVT may happen in the patients with femoral shaft fracture, mostly involving the near end. Peak time of thrombus was 3 days before injury and 1 day after surgery in both groups. The incidence of DVT may be associated with the injury violence. The ap-propriate critical value of D-dimer may be 3.6 mg/L In 1 days before surgery. The change trend of D-dimer was similar to that of thrombosis