老年粗隆间骨折后发生下肢深静脉血栓的多因素分析

目的下肢深静脉血栓是老年创伤患者最常见并发症之一，本研究目的在于探究老年粗隆间骨折后下肢深静脉血栓的发生率、血栓位置及相关因素。 方法回顾性分析天津南开医院和河北省人民医院于2015年1月至2019年6月收治的老年粗隆间骨折患者。患者入院后经常规超声多普勒扫描以诊断双下肢深静脉血栓（DVT），将有DVT的患者归为病例组，无DVT者归为对照组。患者的资料由住院病历获得，包括人口学资料、合并症、受伤相关数据和入院实验室检验结果。采用单因素χ²或Student-t检验评估两组患者的差异性，并采用二元logistic回归分析确定发生DVT的相关危险因素。 结果共673例患者纳入本研究，125（18.6%）例患者诊断含有DVT；其中75（60.0%）例为远端型，37（29.6%）例为近端型，13（10.4%）例为混合型DVT。74.4%（93/125）的患者DVT发生在骨折侧肢体，16.8%（11/125）发生于双侧肢体，8.8%（21/125）发生于未骨折侧。多因素logistic回归分析显示，受伤至入院时间、D-二聚体升高（>1.73 mg/L）、红细胞（RBC）减少（男，<4*10¹²/L；女，<3.5*10¹²/L）、周围血管病史、超重和肥胖（以正常BMI为参考）是DVT发生的独立相关因素。 结论本研究结果提示老年粗隆间骨折患者入院时DVT发生率较高，近端DVT达到7.4%。多个相关危险因素与DVT独立相关，这些流行病学数据有助于预测血栓发生、危险评估及针对性术前筛查。

Multifactor analysis of risk factors associated with deep venous thrombosis (DVT) in lower extremity after intertrochanteric fractures in the elderly

ObjectiveDeep venous thrombosis (DVT) of lower limbs is one of the most common complications in elderly patients with trauma. The purpose of this study was to investigate the incidence, location and related risk factors of deep venous thrombosis (DVT) of lower extremities after intertrochanteric fractures in the elderly. MethodsA retrospective analysis was performed on the elderly intertrochanteric fracture patients admitted to Tianjin Nankai hospital and General Hospital of Hebei from January 2015 to June 2019. After admission, the patients were diagnosed with deep vein thrombosis (DVT) by routine ultrasound doppler scanning. Patients with DVT were assigned to the case group and those without DVT to the control group. Patient data were obtained from inpatient records, including demographic data, comorbidities, injury-related data, and inpatient laboratory test results. Univariate Chi-square or Student-t test was used to evaluate the difference between the two groups, and multivariate logistic regression analysis was used to determine the risk factors for DVT. ResultsA total of 673 patients were included in this study, and 125(18.6%) patients were diagnosed with DVT. Among them, 75(60.0%) were of the distal DVT, 37(29.6%) were proximal, and 13 (10.4%) were hybrid DVT. In 74.4% (93/125) of patients, DVT occurred in the fractured limb, 16.8% (11/125) in the bilateral limb, and 8.8% (21/125) in the non-fractured limb. Multivariate logistic regression analysis showed that from the time from injury to admission, increased D-dimer level (> 1.73mg/L) and RBC reduction (male, <4*10¹²/L; female, <3.5*10¹²/L), peripheral vascular history, overweight and obesity (with normal BMI as reference) were independent factors associated with DVT. ConclusionsThe incidence of admission DVT is high in the elderly patients with intertrochanteric fractures, with proximal DVT reaching 7.4%. Several associated risk factors are independently associated with DVT, and these epidemiological data are useful for predicting thrombogenesis, risk assessment, and targeted preoperative screening.