Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
Department of Orthopaedics, The Affliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China.
Orthop Surg. 2023 Jul;15(7):1806-1813. doi: 10.1111/os.13761. Epub 2023 Jun 13.
Increasing evidence has shown that calf muscular vein thrombosis (CMVT) can develop into proximal deep vein thrombosis, even causing pulmonary embolism. However, opinions about the prevalence and risk factors are still controversial. This study aimed to investigate the prevalence and risk factors for CMVT in elderly patients with hip fractures to facilitate their preoperative management.
We included 419 elderly patients with hip fracture who were treated in the orthopaedic department of our hospital from June 2017 to December 2020. The patients were divided into CMVT and non-CMVT groups based on color Doppler ultrasound screening of the venous system in the lower extremities. Clinical data, such as age, sex, body mass index, time from injury to admission, and laboratory data were collected. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for CMVT. A receiver operating characteristic curve was used to analyze the predictive effectiveness of the model. Finally, the clinical utility of the model was analyzed using decision curve analysis and clinical impact curves.
The prevalence of preoperative CMVT was 30.5% (128/419). Independent predictors of preoperative CMVT identified by univariate and multivariate logistic regression analyses were sex, time from injury to admission, American Society of Anesthesiologists (ASA) classification, C-reactive protein (CRP) level, and D-dimer level (p < 0.05). The area under curve (AUC) was 0.750 (95% CI: 0.699-0.800, p < 0.001) and the sensitivity and specificity were 0.698 and 0.711, respectively, which meant the prediction model has a good efficacy in the prediction of CMVT risk. In addition, the fitting degree of the prediction model was also good (Hosmer-Lemeshow χ = 8.447, p > 0.05). The clinical utility of the model was verified using decision curve analysis and clinical impact curves.
Sex, time from injury to admission, ASA classification, CRP level, and D-dimer levels are independent preoperative predictors of CMVT in elderly patients with hip fractures. Measures should be taken for patients with these risk factors to prevent the occurrence and deterioration of CMVT.
越来越多的证据表明，小腿肌间静脉血栓（CMVT）可发展为近端深静脉血栓，甚至导致肺栓塞。然而，关于其发生率和危险因素的观点仍存在争议。本研究旨在探讨老年髋部骨折患者 CMVT 的发生率和危险因素，以便为其术前管理提供依据。
我们纳入了 2017 年 6 月至 2020 年 12 月在我院骨科治疗的 419 例老年髋部骨折患者。根据下肢静脉系统彩色多普勒超声筛查结果，将患者分为 CMVT 组和非 CMVT 组。收集患者的临床资料，如年龄、性别、体重指数、受伤至入院时间和实验室数据。采用单因素和多因素 logistic 回归分析确定 CMVT 的独立危险因素。采用受试者工作特征曲线分析模型的预测效果。最后，采用决策曲线分析和临床影响曲线分析模型的临床实用性。
术前 CMVT 的发生率为 30.5%（128/419）。单因素和多因素 logistic 回归分析确定的术前 CMVT 独立预测因素为性别、受伤至入院时间、美国麻醉医师协会（ASA）分级、C 反应蛋白（CRP）水平和 D-二聚体水平（p<0.05）。曲线下面积（AUC）为 0.750（95%CI：0.699-0.800，p<0.001），灵敏度和特异度分别为 0.698 和 0.711，表明该预测模型对 CMVT 风险的预测效果较好。此外，该预测模型的拟合度也较好（Hosmer-Lemeshow χ2=8.447，p>0.05）。通过决策曲线分析和临床影响曲线验证了模型的临床实用性。
性别、受伤至入院时间、ASA 分级、CRP 水平和 D-二聚体水平是老年髋部骨折患者 CMVT 的独立术前预测因素。对于具有这些危险因素的患者，应采取措施预防 CMVT 的发生和恶化。
