Abelseth G, Buckley R E, Pineo G E, Hull R, Rose M S
Department of Surgery, Calgary General Hospital, Alberta, Canada.
J Orthop Trauma. 1996;10(4):230-5. doi: 10.1097/00005131-199605000-00002.
Our purpose was to determine the incidence of deep-vein thrombosis (DVT) in patients who have had early operative fixation of fractures of the lower extremity distal to the hip. There is a high incidence of distal thrombosis in patients who have undergone early operative fixation of lower-extremity fractures. The incidence of DVT is higher with proximal extremity fractures than with distal extremity fractures. Most clots are occult and do not progress clinically. Given the high incidence of DVT with femoral and tibial plateau fractures, older age, and longer operating times, anticoagulation prophylaxis may be indicated. Ours was a prospective incidence study. All patients who had had early operative fixation of lower-extremity fractures were eligible (n = 176). Seventy-four were excluded based on specific criteria. The remaining 102 patients underwent lower-extremity venography an average of 9 days after operative fixation of their fractures (range 3-22 days). Eight patients had bilateral lower-extremity fractures. The patients were followed clinically for 6 weeks to identify complications related to venous disease. The overall incidence of clinically occult DVT was 28%. Of the represented fractures, 40% were of the femoral shaft (eight of 20), 43% of the tibial plateau (12 of 28), 22% of the tibial shaft (12 of 54), and 12.5% of the tibial plafond (one of eight). Four of the thrombi were proximal to the popliteal fossa. Four of the patients had clinical evidence of pulmonary embolism while in the hospital. One of them had objective confirmation on further testing. No patient had clinical evidence of pulmonary emboli as an outpatient by follow-up criteria. The incidence of DVT has not been determined for patients with early stabilization of lower-extremity fractures. This study suggests a higher DVT incidence in more proximal fractures, but little risk of embolization. Thrombus formation proximal to the popliteal fossa is rare. Older age, longer operating times, and longer times before fracture fixation all correlate with an increased incidence of DVT.
我们的目的是确定髋部以下下肢骨折早期手术固定患者深静脉血栓形成（DVT）的发生率。接受下肢骨折早期手术固定的患者远端血栓形成的发生率较高。近端肢体骨折患者的DVT发生率高于远端肢体骨折患者。大多数血栓是隐匿性的，临床上不会进展。鉴于股骨和胫骨平台骨折、老年患者以及手术时间较长时DVT的发生率较高，可能需要进行抗凝预防。我们进行的是一项前瞻性发生率研究。所有接受下肢骨折早期手术固定的患者均符合条件（n = 176）。根据特定标准排除了74例患者。其余102例患者在骨折手术固定后平均9天（范围3 - 22天）接受了下肢静脉造影。8例患者为双侧下肢骨折。对患者进行了6周的临床随访，以确定与静脉疾病相关的并发症。临床上隐匿性DVT的总体发生率为28%。在所示骨折中，40%为股骨干骨折（20例中的8例），43%为胫骨平台骨折（28例中的12例），22%为胫骨干骨折（54例中的12例），12.5%为胫骨平台骨折（8例中的1例）。4个血栓位于腘窝近端。4例患者在住院期间有肺栓塞的临床证据。其中1例经进一步检查得到客观证实。按照随访标准，没有患者在门诊时有肺栓塞的临床证据。下肢骨折早期稳定患者的DVT发生率尚未确定。本研究表明，近端骨折的DVT发生率较高，但栓塞风险较小。腘窝近端血栓形成罕见。老年、手术时间较长以及骨折固定前时间较长均与DVT发生率增加相关。
