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中华老年骨科与康复电子杂志 ›› 2020, Vol. 06 ›› Issue (03) : 128 -135. doi: 10.3877/cma.j.issn.2096-0263.2020.03.002

所属专题: 文献

髋部骨折

老年粗隆间骨折后发生下肢深静脉血栓的多因素分析
刘大伟1, 牛帅2,()   
  1. 1. 020025 天津南开医院骨科
    2. 050051 石家庄,河北省人民医院血管外科
  • 收稿日期:2020-03-07 出版日期:2020-06-05
  • 通信作者: 牛帅
  • 基金资助:
    河北省卫生厅课题(20190384)

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

Dawei Liu1, Shuai Niu2,()   

  1. 1. Department of Orthopaedic Surgery, Tianjin Nankai Hospital, Tianjin 020025, China
    2. Department of Vascular Surgery, Hebei General Hospital, Shijiazhuang 050051, China
  • Received:2020-03-07 Published:2020-06-05
  • Corresponding author: Shuai Niu
引用本文:

刘大伟, 牛帅. 老年粗隆间骨折后发生下肢深静脉血栓的多因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2020, 06(03): 128-135.

Dawei Liu, Shuai Niu. Multifactor analysis of risk factors associated with deep venous thrombosis (DVT) in lower extremity after intertrochanteric fractures in the elderly[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(03): 128-135.

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。

Objective

Deep 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.

Methods

A 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.

Results

A 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.

Conclusions

The 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.

图3 女性,83岁,股骨粗隆间骨折,股总静脉血栓
图4 采用ROC曲线确定D-dimer最优截断值为1.73 mg/L,此时敏感度和特异度分别为0.588和0.565
表1 老年粗隆间骨折患者DVT组(n=125)和非DVT组(n=548)的单因素对比分析
变量 DVT组[125(18.6%)] 非DVT组[548(81.4%)] 统计值(χ2t P
性别(男性) 47(37.6) 207(37.8) 0.001 0.971
年龄(岁) 76.8±8.6 76.6±8.7 0.137 0.785
居住地     1.687 0.194
  农村 80(64.0) 316(57.7)    
  城市 45(36.0) 232(42.3)    
BMI(kg/m2 24.6±4.1 23.5±3.3 7.186 0.002
18.5~23.9 51(40.8) 302(55.1) 12.858 0.005
<18.5 9(7.2) 31(5.7)    
24.0~27.9 42(33.6) 165(30.1)    
≥28.0 23(18.4) 50(9.1)    
吸烟 18(14.4) 76(13.9) 0.024 0.877
糖尿病 31(24.8) 149(27.2) 0.297 0.586
高血压 74(59.2) 323(58.9) 0.003 0.958
脑血管病 44(35.2) 205(37.4) 0.213 0.644
心脏病 42(33.6) 179(32.7) 0.040 0.841
肺病史 3(2.4) 37(6.7) 3.448 0.086
肿瘤 4(3.2) 13(2.4) 0.283 0.595
肝病 4(3.2) 17(3.1) 0.003 0.955
肾病 4(3.2) 20(3.6) 0.060 0.807
类风湿及结缔组织病 0(0.0) 12(2.2) 2.787 0.095
周围血管病 10(8.0) 18(3.3) 5.676 0.017
过敏史 27(21.6) 124(22.6) 0.062 0.804
任意手术史 35(28.0) 160(29.2) 0.071 0.790
骨折分型(AO/OTA)     11.431 0.003
A1 19(14.1) 148(27.5)    
A2 83(61.5) 296(55.0)    
A3 33(24.4) 94(17.5)    
受伤至入院间隔(d) 1.64±2.21 1.26±1.93 8.145 0.002
TP(<60 g/L) 84(67.2) 311(56.8) 4.583 0.032
ALB(<35 g/L) 89(71.2) 343(62.6) 3.282 0.070
LDH(>250 u/L) 39(31.2) 160(29.2) 0.196 0.658
TC(>5.2 mmol/L) 10(8.0) 37(6.8) 0.244 0.621
TG(>1.7 mmol/L) 6(4.8) 36(6.6) 0.545 0.461
HDL-C(<1.1 mmol/L) 62(49.6) 232(42.3) 2.183 0.140
Na+(<135 mmol/L) 32(25.6) 103(18.8) 2.939 0.086
FBG(>6.1 mmol/L) 80(64.0) 321(58.6) 1.243 0.265
NEU(>6.3*109/L) 66(52.8) 288(54.8) 0.174 0.679
LYM(<1.1*109/L) 62(49.6) 282(51.6) 0.141 0.693
RBC(<下限值) 94(75.2) 295(53.8) 19.053 <0.001
HGB(<下限值) 89(71.2) 312(56.9) 8.602 0.003
PLT(>350*109/L) 14(11.2) 62(11.3) 0.001 0.971
PDW     0.706 0.703
  12~18.1% 113(90.4) 491(89.6)    
  <12% 10(8.0) 41(7.5)    
  >18.1% 2(1.6) 16(2.9)    
D-二聚体(>0.3 mg/L) 108(86.4) 475(86.7) 0.007 0.934
D-二聚体(>0.5 mg/L) 102(81.6) 443(80.8) 0.038 0.845
D-二聚体(>1.73 mg/L) 69(55.2) 224(40.9) 8.495 0.004
表2 老年粗隆间骨折入院诊断DVT的多因素Logistics回归分析
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