足部骨折术后深静脉血栓形成的发生率及相关血液生物标志物。

Incidence and Hematological Biomarkers Associated With Preoperative Deep Venous Thrombosis Following Foot Fractures.

机构信息

Hebei Orthopedic Clinical Research Center, the 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.

Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.

出版信息

Foot Ankle Int. 2020 Dec;41(12):1563-1570. doi: 10.1177/1071100720943844. Epub 2020 Aug 18.

DOI:10.1177/1071100720943844

PMID:32806946

Abstract

BACKGROUND

This study was designed to investigate the incidence and hematological biomarker levels that are associated with deep venous thrombosis (DVT) following closed foot fractures (except calcaneal fractures).

METHODS

A retrospective analysis of data on patients presenting with closed foot fractures (excluding the calcaneus) between October 2014 and December 2018 was conducted. Duplex ultrasonography was used to screen preoperative DVT of bilateral lower extremities. Data on demographics, comorbidities, types of fracture, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were carried out to determine the independent risk factors associated with DVT.

RESULTS

A total of 537 patients were included, among whom 28 patients had preoperative DVTs, indicating a crude incidence rate of 5.2%. In isolated closed foot fractures, DVT occurred in 12 (2.9%) out of 410 patients, while in patients with concurrent fracture in other locations, 16 (12.6%) out of 127 patients developed DVT. The average interval between fracture occurrence and diagnosis of DVT was 4.2 days (median, 2 days), ranging from 0 to 17 days. Twenty-four patients (85.7%) developed DVT in the injured extremity, 3 (10.7%) in the uninjured extremity, and 1 (3.5%) in bilateral extremities. Seven risk factors were identified to be associated with DVT, including alcohol consumption, concomitant other fractures, platelet distribution width (PDW) <12%, high-density lipoprotein cholesterol (HDL-C) <1.1mmol/L, serum alkaline phosphatase (ALP) >100 U/L, serum sodium concentration (Na) <135 mmol/L, and D-dimer >0.5 mg/L.

CONCLUSION

Being aware of the prevalence of DVT in closed foot fractures can help physicians to carry out the overall assessment, risk stratification, and individual prevention programs.

LEVEL OF EVIDENCE

Level III, a prospective cohort study.

摘要

背景

本研究旨在调查闭合性足部骨折（不包括跟骨骨折）后深静脉血栓形成（DVT）的发生率和与 DVT 相关的血液生物标志物水平。

方法

对 2014 年 10 月至 2018 年 12 月期间就诊的闭合性足部骨折（不包括跟骨）患者的数据进行回顾性分析。使用双能超声对双侧下肢进行术前 DVT 筛查。收集患者的人口统计学、合并症、骨折类型和入院时的实验室生物标志物数据。采用单因素分析和多因素 logistic 回归分析确定与 DVT 相关的独立危险因素。

结果

共纳入 537 例患者，其中 28 例患者术前存在 DVT，粗发生率为 5.2%。在单纯闭合性足部骨折中，410 例患者中有 12 例（2.9%）发生 DVT，而在其他部位合并骨折的患者中，127 例中有 16 例（12.6%）发生 DVT。骨折发生与 DVT 诊断之间的平均间隔时间为 4.2 天（中位数，2 天），范围为 0 至 17 天。24 例（85.7%）患者在受伤肢体出现 DVT，3 例（10.7%）患者在未受伤肢体出现 DVT，1 例（3.5%）患者在双侧肢体出现 DVT。确定了 7 个与 DVT 相关的危险因素，包括饮酒、合并其他骨折、血小板分布宽度（PDW）<12%、高密度脂蛋白胆固醇（HDL-C）<1.1mmol/L、血清碱性磷酸酶（ALP）>100 U/L、血清钠浓度（Na）<135mmol/L 和 D-二聚体>0.5mg/L。