股骨干骨折患者围手术期发生下肢深静脉血栓的特点

Time course of perioperative deep venous thrombosis of lower limbs in patients with femoral shaft fracture

摘要:

目的了解采用股骨髓内钉固定治疗股骨干骨折的患者围手术期下肢深静脉血栓发生的时间分布特点。方法选取2010 年10 月-2016 年10 月208 例在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，根据患者术前是否采用预防性抗凝措施分为抗凝组和非抗凝组，两组患者分别于伤后第1、3、5 及超过5 天和术后第2、5、7 及14 天8 个时间点分别进行下肢血管彩色多普勒检查，统计总的血栓发生例数和发生率，并对两组患者进行比较。统计不同时间点两组患者新发生血栓的病例数和发生率，通过频数分布表分析伤后和术后血栓发生的高峰时间。结果根据纳入标准共纳入208 例患者，其中术前抗凝组115 例，有16 例发生血栓，发生率13.91%，术前未抗凝组93 例，发生深静脉血栓27 例，发生率29.03%。两组比较差异有统计学意义（χ2=7.167，p =0.007）。两组患者血栓发生的高峰时间是伤后第3 天和术后第1 天。结论股骨干骨折患者围手术期，深静脉血栓发生的高峰时间是伤后前第3 天和术后第1 天。患肢深静脉血栓的预防应从伤后即开始实施，伤后就进行药物预防性抗凝可降低深静脉血栓的发生率。

Abstract:

Objective To analyze the incidence of the perioperative deep venous thrombosis of lower limbs at different time slots in femoral shaft fracture patients repaired by femoral intramedullar nail fixation. Methods In this study, 208 cases with diagnosis of femoral shaft fracture and performed closed reduction and femoral intramedullar nail fixation were selected from the Department of Orthopedics, the Affiliated Hospital of Chengde Medical College in China from October 2010 to October 2016. They were divided into two groups i.e. LMWH group (n = 115) and non-LMWH group (n = 93) based on administration low-molecular-weight heparins (LMWH) or not before operation. Vascular Doppler ultrasound was conducted on day 1, 3 and 5 and more than 5 days after trauma, and day 2, 5, 7 and 14 after surgery. The total number of cases and incidence of thrombosis were recorded and compared between the two groups. The number of cases and the incidence of new thrombosis were recorded at different time points in both groups. Frequency distribution table was used to analyze the time of suffering thrombosis after injury and surgery. Results Among 208 cases,16 cases in the LMWH group (n = 115) had deep vein thrombosis with an incidence of 13.91%, and 27 cases in the non-LMWH group (n = 93) had deep vein thrombosis with an incidence of 29.03%. The difference between the two groups was statistically significant (x2 = 7.167,p = 0.007). Peak time of thrombosis was 3 days after injury and 1 day after surgery in both groups. Conclusions The peak time of deep vein thrombosis is day 3 after injury and day 1 after surgery. The prevention of deep vein thrombosis after limb injuries should be implemented, for prophylactic anticoagulant after injury can significantly reduce the incidence of deep vein thrombosis.