跟骨骨折术前深静脉血栓形成的发生率

Incidence of Preoperative Deep Vein Thrombosis in Calcaneal Fractures.

作者信息

Williams Joan R, Little Milton T M, Kramer Patricia A, Benirschke Stephen K

机构信息

*Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA; †Department of Orthopaedic Surgery, Cedars-Sinai, Los Angeles, CA; ‡University of Washington Seattle, WA; and §Harborview Medical Center, University of Washington Seattle, WA.

出版信息

J Orthop Trauma. 2016 Jul;30(7):e242-5. doi: 10.1097/BOT.0000000000000568.

DOI:10.1097/BOT.0000000000000568

PMID:26913595

Abstract

OBJECTIVES

This study examined the incidence and risk factors of preoperative deep vein thrombosis (DVT) in patients presenting to an outpatient setting with an isolated calcaneal fracture.

DESIGN

Retrospective chart review.

SETTING

All patients included in the study presented to the treating surgeon at a Level I trauma center with isolated calcaneal fractures as an outpatient between 2005 and 2013.

METHODS

These patients were either referred from outside hospitals, had been evaluated in the emergency department initially and presented for definitive care, or presented initially to the outpatient clinic. Patients included were over the age of 18, had a preoperative duplex ultrasonography of bilateral lower extremities per the treating surgeon's protocol, and had at minimum 6 weeks follow-up. Patients were excluded if they were a polytrauma, had a documented hypercoagulable state, or were on baseline pharmacologic anticoagulation for another condition. All patients had a preoperative duplex ultrasound of both lower extremities to evaluate for DVT at least 7 days after injury.

MAIN OUTCOME MEASURE

Patients found to have a preoperative DVT were compared with those who did not have preoperative DVT for possible risk factors.

RESULTS

One hundred fifty-nine patients qualified for our study and of these, 19 (12%) were found to have a DVT preoperatively, almost all of which were in distal veins. All risk factors, including age, sex, and body mass index were analyzed as continuous variables. Older age was found to be a risk factor for DVT (P = 0.009, Odds Ratio = 1.06, 95% CI, 1.01-1.11). All other predictor variables, including body mass index (P = 0.05) and sex (P = 0.08), were not statistically significant predictors in our sample.

CONCLUSIONS

The incidence of preoperative DVT found here is almost 2 times as high as any previously published examination of lower extremity injuries. Physicians should be aware of this increase so they may counsel patients about the risks of DVTs and the likelihood of any sequelae from developing a DVT that may affect a patient's recovery.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

本研究调查了门诊孤立性跟骨骨折患者术前深静脉血栓形成（DVT）的发生率及危险因素。

设计

回顾性病历审查。

研究背景

2005年至2013年间，所有纳入本研究的患者均为一级创伤中心的门诊患者，均为孤立性跟骨骨折，并由主治外科医生进行治疗。

方法

这些患者要么是从外院转诊而来，要么最初在急诊科接受评估后前来接受确定性治疗，要么最初是到门诊就诊。纳入的患者年龄超过18岁，按照主治外科医生的方案接受了术前双侧下肢的双功超声检查，并且至少随访6周。如果患者为多发伤、有记录的高凝状态或因其他疾病正在接受基线药物抗凝治疗，则将其排除。所有患者在受伤后至少7天接受术前双下肢双功超声检查以评估是否存在DVT。

主要观察指标

将术前发现有DVT的患者与术前未发现DVT的患者进行比较，以寻找可能的危险因素。

结果

159例患者符合本研究标准，其中19例（12%）术前发现有DVT，几乎所有DVT均位于远端静脉。所有危险因素，包括年龄、性别和体重指数，均作为连续变量进行分析。发现年龄较大是DVT的危险因素（P = 0.009，优势比 = 1.06，95%可信区间，1.01 - 1.11）。所有其他预测变量，包括体重指数（P = 0.05）和性别（P = 0.08），在我们的样本中均不是统计学上显著的预测因素。