Shin Won Chul, Woo Seung Hun, Lee Seung-Jun, Lee Jung Sub, Kim Choongrak, Suh Kuen Tak
1Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea 2Department of Orthopedic Surgery, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Republic of Korea 3Department of Statistics, Pusan National University, Busan, Republic of Korea.
J Bone Joint Surg Am. 2016 Dec 21;98(24):2089-2095. doi: 10.2106/JBJS.15.01329.
This retrospective cohort study investigated the prevalence of and risk factors for preoperative venous thromboembolism (VTE) in patients with a hip fracture and a delay of >24 hours from injury to surgery.
This observational study included 208 patients with a hip fracture surgically treated at 1 university hospital between December 2010 and August 2014. Patients underwent indirect multidetector computed tomographic (MDCT) venography for preoperative VTE detection after admission. Overall VTE risk and median time from injury to CT scan were calculated. Age, sex, fracture type, time from injury to CT scan, body mass index, preinjury mobility score, previous anticoagulation treatment, previous hospitalization for VTE, varicose veins, and medical comorbidities were considered potential risk factors.
The prevalence of preoperative VTE was 11.1% (23 of 208 patients), including 12 patients with deep vein thrombosis alone, 7 patients with pulmonary embolism alone, and 4 patients with both. The mean time from injury to CT scan was 4.9 days. The delay from the time of injury to CT scan averaged 7.6 days for patients who developed preoperative VTE, compared with 4.2 days for patients who had not developed VTE. In the adjusted models, female sex, subtrochanteric fracture, pulmonary disease, cancer, previous hospitalization for VTE, and varicose veins were risk factors for VTE. The final multivariate logistic regression analysis demonstrated that female sex (odds ratio [OR] = 5.86; 95% confidence interval [CI] = 1.21 to 28.21), subtrochanteric fracture (OR = 22.17; 95% CI = 4.02 to 122.06), pulmonary disease (OR = 21.10; 95% CI = 5.35 to 83.21), and previous hospitalization for VTE (OR = 16.36; 95% CI = 3.41 to 78.43) increased the risk of VTE.
Our findings show a high prevalence of preoperative VTE in patients with a hip fracture. Therefore, preoperative investigation for VTE should be routinely considered for patients in whom surgery is delayed for >24 hours. At this time, indirect MDCT venography seems to be effective and useful.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
这项回顾性队列研究调查了髋部骨折且受伤至手术延迟超过24小时的患者术前静脉血栓栓塞症（VTE）的患病率及危险因素。
这项观察性研究纳入了2010年12月至2014年8月间在1所大学医院接受手术治疗的208例髋部骨折患者。患者入院后接受间接多排螺旋计算机断层扫描（MDCT）静脉造影以检测术前VTE。计算总体VTE风险及从受伤至CT扫描的中位时间。年龄、性别、骨折类型、从受伤至CT扫描的时间、体重指数、受伤前活动评分、既往抗凝治疗、既往因VTE住院、静脉曲张及合并症被视为潜在危险因素。
术前VTE的患病率为11.1%（208例患者中的23例），包括12例单独发生深静脉血栓形成的患者、7例单独发生肺栓塞的患者及4例两者均有的患者。从受伤至CT扫描的平均时间为4.9天。发生术前VTE的患者从受伤至CT扫描的延迟平均为7.6天，未发生VTE的患者为4.2天。在校正模型中，女性、转子下骨折、肺部疾病、癌症、既往因VTE住院及静脉曲张为VTE的危险因素。最终的多变量逻辑回归分析表明，女性（比值比[OR]=5.86；95%置信区间[CI]=1.21至28.21）、转子下骨折（OR=22.17；95%CI=4.02至122.06）、肺部疾病（OR=21.10；95%CI=5.35至83.21）及既往因VTE住院（OR=16.36；95%CI=3.41至78.43）会增加VTE风险。
我们的研究结果显示髋部骨折患者术前VTE的患病率较高。因此，对于手术延迟超过24小时的患者，应常规考虑进行术前VTE检查。此时，间接MDCT静脉造影似乎有效且有用。
预后IV级。有关证据水平的完整描述，请参阅《作者须知》。
