老年股骨转子间骨折术后深静脉血栓形成（DVT）的发生率及风险预测模型的建立。
Prevalence of preoperative Deep Venous Thrombosis (DVT) following elderly intertrochanteric fractures and development of a risk prediction model.
机构信息
Department of Traditional Chinese Medicine Orthopaedics, the 3Rd Hospital of Shijiazhuang, NO.15 Tiyu South Street, Shijiazhuang, 050000, Hebei, People's Republic of China.
Department of Nursing, the 3Rd Hospital of Shijiazhuang, Shijiazhuang, 050000, Hebei, People's Republic of China.
出版信息
BMC Musculoskelet Disord. 2022 May 4;23(1):417. doi: 10.1186/s12891-022-05381-y.
BACKGROUND
This study aimed to investigate the prevalence of preoperative deep venous thrombosis (DVT) following intertrochanteric fractures in the elderly and identify the associated factors, based on which a risk prediction model was developed.
METHOD
This was a retrospective single-center study of elderly patients presenting with intertrochanteric fractures between our institution between January 2017 and December 2020. Patients' duplex ultrasound (DUS) or venography results were retrieved to evaluate whether they had a preoperative deep venous thrombosis (DVT) of bilateral extremities, whereby patients were dichotomized. Various variables of interest on demographics, comorbidities, injury and biomarkers were extracted and their relationship between DVT were investigated. Statistically significant variables tested in multivariate logistics regression analyses were used to develop a risk prediction model.
RESULTS
There were 855 patients eligible to be included in this study, and 105 were found to have preoperative DVT, with a prevalence rate of 12.3%. Ten factors were tested as significantly different and 2 marginally significant between DVT and non-DVT groups in the univariate analyses, but only 6 demonstrated the independent effect on DVT occurrence, including history of a VTE event (OR, 4.43; 95%CI, 2.04 to 9.62), time from injury to DVT screening (OR, 1.19; 95%CI, 1.13 to 1.25), BMI (OR, 1.11; 95%CI, 1.04-1.18), peripheral vascular disease (OR, 2.66; 95%CI, 1.10 to 6.40), reduced albumin (2.35; 95%CI, 1.48 to 3.71) and D-Dimer > 1.0 mg/L(OR, 1.90; 95%CI, 1.13 to 3.20). The DVT risk model showed an AUC of 0.780 (95%CI, 0.731 to 0.829), with a sensitivity of 0.667 and a specificity of 0.777.
CONCLUSION
Despite without a so high prevalence rate of DVT in a general population with intertrochanteric fracture, particular attention should be paid to those involved in the associated risk factors above. The risk prediction model exhibited the improved specificity, but its validity required further studies to verify.
背景
本研究旨在调查老年人股骨转子间骨折术后下肢深静脉血栓（DVT）的发生率，并确定相关因素，在此基础上建立风险预测模型。
方法
这是一项回顾性单中心研究，纳入了 2017 年 1 月至 2020 年 12 月期间我院收治的股骨转子间骨折老年患者。通过双下肢超声（DUS）或静脉造影检查评估患者是否存在术前双侧下肢深静脉血栓（DVT），将患者分为 DVT 组和非 DVT 组。提取感兴趣的人口统计学、合并症、损伤和生物标志物等变量，并分析其与 DVT 的关系。多变量逻辑回归分析测试有统计学意义的变量，用于建立风险预测模型。
结果
本研究共纳入 855 例患者，其中 105 例患者术前发现 DVT，发生率为 12.3%。单因素分析显示，DVT 组与非 DVT 组有 10 个因素存在显著差异，2 个因素具有边缘统计学意义，但只有 6 个因素对 DVT 发生有独立影响，包括静脉血栓栓塞（VTE）事件史（OR，4.43；95%CI，2.04 至 9.62）、从受伤到 DVT 筛查的时间（OR，1.19；95%CI，1.13 至 1.25）、体重指数（OR，1.11；95%CI，1.04 至 1.18）、外周血管疾病（OR，2.66；95%CI，1.10 至 6.40）、白蛋白降低（OR，2.35；95%CI，1.48 至 3.71）和 D-二聚体>1.0mg/L（OR，1.90；95%CI，1.13 至 3.20）。DVT 风险模型的 AUC 为 0.780（95%CI，0.731 至 0.829），灵敏度为 0.667，特异度为 0.777。
结论
尽管股骨转子间骨折患者中 DVT 的总体发生率不高，但仍应特别关注上述相关危险因素。该风险预测模型的特异性有所提高，但需要进一步的研究来验证其有效性。
Zotero 插件