特定孤立下肢骨折术后深静脉血栓形成的发生率和部位。
Perioperative incidence and locations of deep vein thrombosis following specific isolated lower extremity fractures.
机构信息
Department of Orthopaedic Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, China.
Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA.
出版信息
Injury. 2018 Jul;49(7):1353-1357. doi: 10.1016/j.injury.2018.05.018. Epub 2018 May 22.
PURPOSE
To determine perioperative incidence and locations of deep vein thrombosis (DVT) in injured and uninjured lower extremities following isolated lower extremity fractures (ILEFs).
METHODS
Retrospective analysis of a prospectively collected data of a consecutive patient series with ILEFs who underwent surgical treatment between September 2014 and September 2017 was performed. Patients' bilateral lower extremities were screened for DVT with duplex ultrasonography (DUS) before and after surgery. DVT occurrence was analyzed by location of DVT and fracture site. All patients received pharmacologic thromboprophylaxis while hospitalized. Data on demographics, time to surgery, time of DUS examinations, length of hospital stay and symptomatic pulmonary embolism (PE) was collected.
RESULTS
1825 patients were included in the study. The incidence of symptomatic PE was 1.6%. All patients were screened with DUS of the bilateral lower extremities in a mean of 3.5 days (range: 0-18 days) after injury, and a mean of 3.6 days (range: 1-11 days) after surgery. Preoperative DUS detected DVT in 547 patients (30.0%), including 3.7% of patients with proximal DVT. 792 patients (43.4%) were found to have a DVT postoperatively, but only 6.2% of patients with proximal DVT. Proximal DVT was detected postoperatively of the represented fractures: 6.5% of the hip, 14.5% of the femoral shaft, 4.5% of the tibial plateau, 4.6% of the tibial shaft, 1.7% of the patellar, and 2.0% of the peri-ankle. Interestingly, the rate of DVT in an uninjured lower limb was significantly higher postoperatively compared to preoperatively (16.4% vs. 4.9%), however, only 0.2% of patients had proximal DVT.
CONCLUSIONS
While the perioperative incidence of overall DVT is high following ILEFs, the majority were distal DVT, and the rate of symptomatic PE was low. Femoral shaft fractures were associated with the highest incidence for proximal DVT. The incidence was lower in more distal fractures. The majority of patients diagnosed with DVT postoperatively had already shown symptoms of DVT prior to surgery. DVT can occur in both the injured and uninjured leg, with an obviously higher incidence in the injured leg. The incidence of proximal DVT in an uninjured leg is rare.
目的
确定孤立下肢骨折（ILEF）后受伤和未受伤下肢深静脉血栓形成（DVT）的围手术期发生率和部位。
方法
对 2014 年 9 月至 2017 年 9 月间连续接受 ILEF 手术治疗的患者进行前瞻性收集数据的回顾性分析。在手术前后，使用双功能超声（DUS）对患者双侧下肢进行 DVT 筛查。根据 DVT 部位和骨折部位分析 DVT 的发生情况。所有患者在住院期间均接受药物血栓预防治疗。收集人口统计学、手术时间、DUS 检查时间、住院时间和症状性肺栓塞（PE）的数据。
结果
本研究共纳入 1825 例患者。症状性 PE 的发生率为 1.6%。所有患者均在受伤后平均 3.5 天（范围：0-18 天）和术后平均 3.6 天（范围：1-11 天）进行双侧下肢 DUS 筛查。术前 DUS 发现 547 例患者（30.0%）存在 DVT，其中 3.7%的患者为近端 DVT。792 例（43.4%）患者术后发现 DVT，但仅 6.2%的患者为近端 DVT。术后发现代表骨折的近端 DVT：髋关节 6.5%，股骨干 14.5%，胫骨平台 4.5%，胫骨骨干 4.6%，髌骨 1.7%，踝周 2.0%。有趣的是，与术前相比，术后未受伤下肢 DVT 的发生率明显更高（16.4% vs. 4.9%），但仅 0.2%的患者存在近端 DVT。
结论
尽管 ILEF 后总体 DVT 的围手术期发生率较高，但大多数为远端 DVT，且症状性 PE 的发生率较低。股骨干骨折与近端 DVT 的发生率最高相关。更靠近远端的骨折发生率较低。大多数术后诊断为 DVT 的患者在手术前已出现 DVT 症状。DVT 可发生于受伤和未受伤的下肢，受伤下肢的发生率明显更高。未受伤下肢近端 DVT 的发生率罕见。
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