Manafi Rasi Alireza, Kazemian Gholamhossein, Emami Moghadam Mohammad, Tavakoli Larestani Reza, Fallahi Amirhossein, Nemati Ali, Nazari Maryam, Fallahi Fateme, Safari Saeed
Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital, Tehran, IR Iran.
Department of Physical Medicine and Rehabilitation, Tehran University of Medical Sciences, Firuzgar Hospital, Tehran, IR Iran.
Trauma Mon. 2013 Winter;17(4):367-9. doi: 10.5812/traumamon.9158. Epub 2013 Jan 15.
There is controversy regarding routine prophylaxis for deep vein thrombosis (DVT) in patients treated via a short leg cast or splint following lower extremity trauma.
The main aim of this study is to evaluate the incidence of DVT and need for chemoprophylaxis in these patients.
Patients with ankle sprains or stable foot/ankle fractures were entered in this cross-sectional study. Serum D-dimer levels were measured 2 weeks following fixation. If the D-dimer levels were above 0.2 micrograms/ml the test was considered positive and the patient was referred for Doppler ultrasound examination (DUE) to confirm or rule out the diagnosis of DVT. Finally, the incidence of DVT was calculated and the role of predisposing factors was investigated.
There were 95 patients with an average age of 38 ± 13.7 (77.9% males); 46 patients had at least one risk factor for DVT. The D-dimer test was positive in 21(22.1%) patients. DVT was confirmed by DUE in 3 patients (3.1%). The incidence of DVT significantly increased in the presence of 3 or more risk factors (P = 0.01).
It seems that DVT is not a common complication of below knee fixation and chemoprophylaxis is not necessary when the patient has less than 3 predisposing factors. With 3 or more risk factors chemoprophylaxis and periodic follow-ups must be considered.
对于下肢创伤后采用短腿石膏或夹板治疗的患者，深静脉血栓形成（DVT）的常规预防存在争议。
本研究的主要目的是评估这些患者中DVT的发生率以及化学预防的必要性。
本横断面研究纳入了踝关节扭伤或稳定的足部/踝关节骨折患者。固定后2周测量血清D - 二聚体水平。如果D - 二聚体水平高于0.2微克/毫升，则该检测被视为阳性，患者被转诊进行多普勒超声检查（DUE）以确诊或排除DVT诊断。最后，计算DVT的发生率并研究诱发因素的作用。
共有95例患者，平均年龄38±13.7岁（男性占77.9%）；46例患者至少有一项DVT危险因素。21例（22.1%）患者D - 二聚体检测呈阳性。3例（3.1%）患者经DUE确诊为DVT。存在3个或更多危险因素时，DVT的发生率显著增加（P = 0.01）。
似乎DVT不是膝下固定的常见并发症，当患者的诱发因素少于3个时，无需进行化学预防。存在3个或更多危险因素时，必须考虑化学预防和定期随访。
