The clinical value of bedside ultrasound in the screening of perioperative lower extremity deep vein thrombosis in elderly patients with femoral neck fracture

doi:10.3877/cma.j.issn.2096-0263.2018.02.002

Abstract

Abstract:

Objective

To investigate the clinical value of bedside ultrasound in detection of deep vein thrombosis in elderly patients with femoral neck fracture.

Methods

A retrospective study was performed in patients with femoral neck fractures who underwent bilateral ultrasound in department of Sports Medicine and Adult Reconstructive Surgery of Drum Tower Hospital Affiliated to Medical School of Nanjing University from January 2016 to March 2017. The diameter of blood vessel, location, echo and blood flow were evaluated. Postoperative ultrasound were conducted routinely during hospitalization and after discharge.

Results

A total of 135 patients were enrolled in this study. There were 45 males and 90 females. The average age was 76±8 years old and the average body mass index was 22±3 kg/m². Forty-five cases were diagnosed DVT. Seven cases were proximal DVT and thirty eight were distal. According to the anatomical location, one located in the iliac vein, four located in the femoral veins, four located in the popliteal veins, five cases located in the peroneal veins and three cases located in the posterior tibia veins, forty one cases located in the muscular vein. Surgeries were postponed in 13 DVT patients and all of them received thrombosis treatment and ultrasound screening every other day. Results showed that 10 cases were significantly improved, two cases had no improvement and one case aggravated, two cases received inferior vena cava filters. During postoperative screening, three preoperative DVTs were found to progress into other veins and all of them received treatment and the follow-up screening showed that no DVT failed off and no pulmonary embolism happened.

Conclusion

Bedside ultrasound can be used in the diagnosis, monitoring and follow up of DVT in patients with femoral neck fracture.

Key words: Thrombosis, Ultrasonography, Femoral neck fractures, Arthroplasty, replacement, hip

Yao Yao, Liang Qiao, Yexian Wang, Junlan Qiu, Zhiming Jiang, Yi Shen, Chengyan Zhu, Dongyang Chen, Zhihong Xu, Dongquan Shi, Jin Dai, Weiwei Zhang, Qing Jiang. The clinical value of bedside ultrasound in the screening of perioperative lower extremity deep vein thrombosis in elderly patients with femoral neck fracture[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2018, 04(02): 70-74.

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Figures/Tables 4

References 13

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组别	例数	性别（例）		体质量指数（kg/m²，±s）	年龄（岁，±s）	高血压（例）		糖尿病（例）		脑梗病史（例）		肿瘤病史（例）
组别	例数	男	女	体质量指数（kg/m²，±s）	年龄（岁，±s）	有	无	有	无	有	无	有	无
非血栓组	90	30	60	22±4	75±9	45	45	18	72	0	60	7	83
血栓组	45	15	30	22±4	78±7	32	13	10	35	20	25	0	45
统计值	?	χ²=0.000		t=0.549	t=-1.853	χ²=5.546		χ²=0.090		χ²=1.588		χ²=2.279
P值	?	1.000		0.584	0.066	0.019		0.764		0.208		0.131

组别	例数	性别（例）		体质量指数（kg/m²，±s）	年龄（岁，±s）	高血压（例）		糖尿病（例）		脑梗病史（例）		肿瘤病史（例）
组别	例数	男	女	体质量指数（kg/m²，±s）	年龄（岁，±s）	有	无	有	无	有	无	有	无
非血栓组	90	30	60	22±4	75±9	45	45	18	72	0	60	7	83
血栓组	45	15	30	22±4	78±7	32	13	10	35	20	25	0	45
统计值	?	χ²=0.000		t=0.549	t=-1.853	χ²=5.546		χ²=0.090		χ²=1.588		χ²=2.279
P值	?	1.000		0.584	0.066	0.019		0.764		0.208		0.131

血栓累及部位		总例数（n=45）
近端血栓		7
?	腘静脉+肌间静脉	3
?	股静脉	2
?	髂静脉+股静脉+肌间静脉	1
?	股静脉+腘静脉+腓静脉+胫后静脉+肌间静脉	1
远端血栓		38
?	肌间静脉	32
?	腓静脉	2
?	腓静脉+肌间静脉	2
?	胫后静脉+肌间静脉	1
?	胫后静脉	1

血栓累及部位		总例数（n=45）
近端血栓		7
?	腘静脉+肌间静脉	3
?	股静脉	2
?	髂静脉+股静脉+肌间静脉	1
?	股静脉+腘静脉+腓静脉+胫后静脉+肌间静脉	1
远端血栓		38
?	肌间静脉	32
?	腓静脉	2
?	腓静脉+肌间静脉	2
?	胫后静脉+肌间静脉	1
?	胫后静脉	1

部位	例数	?	回声表现	血管是否扩张		是否能压闭		血栓边缘与管壁关系		彩色多普勒血流信号
部位	例数	低回声	混合或者高回声	是	否	完全不能	部分能	清晰	不清	无	部分
远端静脉	43*	34	9	30	13	25	18	20	23	30	13
近端静脉	7	6	1	4	3	2	5	5	2	2	5

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