下肢骨折部位与下肢深静脉血栓发生的相关性研究

发布时间：2017-12-31 03:23

本文关键词：下肢骨折部位与下肢深静脉血栓发生的相关性研究　出处：《江苏大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过分析不同部位下肢骨折患者的D-二聚体水平、血栓发生率及发生部位来研究下肢骨折部位与下肢深静脉血栓(Lower ex trem ity deep vein thrombosis,LE DVT)发生的相关性。方法:将本院骨科自2012年1月至2015年12月收治入院的下肢单侧单部位骨折患者纳入观察样本,以下肢血管超声检查检查为LEDVT的筛查及诊断方式。按骨折部位将患者分为5组:足踝骨折、小腿骨折、膝部骨折、股骨干骨折、股骨近端骨折,分析骨折发生侧与血栓发生侧的关联、各组骨折患者的D-二聚体水平及血栓发生率;统计各骨折组血栓的部位,按罹患肺栓风险的高低将各骨折组发生的下肢深静脉血栓分为高风险血栓(乆静脉及乆静脉以上)及低风险血栓(乆静脉以下),研究各骨折组血栓中高、低风险血栓的分布是否有差异。结果:在血栓发生侧与骨折侧的相关性研究中,共127例骨折后形成LE DVT患者,其中左下肢骨折患者73例、右下肢骨折患者54例;其中122例累及单侧下肢、5例累及双侧下肢,共累及132处单侧下肢,其中左下肢血栓72处、右下肢血栓60处;发生在骨折同侧的119处,对侧的13处。LEDVT更易发生在骨折的同侧(P0.05),血栓的左右侧分布与骨折的左右侧分布无统计学差异(P0.05),并且下肢骨折患者发生的LEDVT的左右侧分布与总体LED VT患者的血栓左右侧分布有差异(P0.05);在各组骨折患者中,足踝部骨折组患者的D-二聚体水平(1.81 3.20mg/L)及血栓发生率(0.4%)均低于其它各组(小腿骨折组:3.70 3.95mg/L、3.4%,膝部骨折组:4.26 6.18 mg/L、6.6%,股骨干骨折组:4.49 6.08 mg/L、5.1%,股骨近端骨折组:4.93 5.99 mg/L、5.8%),并且差异有统计学意义(P0.05),而其余骨折组间的D-二聚体水平及血栓发生率的差异无显统计学意义(P0.05);在各骨折组血栓的高、低风险血栓分布的统计中发现膝部骨折组、股骨干骨折组及股骨近端骨折组的高风险血栓所占比依次为66.7%、68.2%、61.3%,均高于小腿骨折组的25.9%(P0.05),而膝部、股骨干、及股骨近端骨折组的高风险血栓所占比的差异无统计学意义(P0.05)。结论:下肢骨折发生后,血栓更易发生在骨折的同侧,左右侧的分布无明显差异;足踝部骨折组患者的D-二聚体水平及血栓发生率较其它组骨折低;膝部、股骨干、股骨近端骨折组患者的血栓发生率高,且以肺栓罹患风险较高的乆静脉及以上静脉血栓为主。
[Abstract]:Objective: through the analysis of different parts of patients with lower limb fractures D- two dimer level, rate and location of lower limbs and deep vein thrombosis of lower extremity fractures (Lower ex trem ity deep thrombosis, vein thrombosis, LE DVT). The correlations between methods: the hospital department of orthopedics from January 2012 to December 2015 admitted to the unilateral single lower limb fracture patients included in the study sample, the lower limb vascular ultrasound examination for the diagnosis and screening of LEDVT. According to the fracture patients were divided into 5 groups: ankle fractures, leg fracture, knee fracture, femoral bone fracture, proximal femoral fractures, fracture analysis and thrombosis associated side side, with D- two the level of D-dimer and the incidence of thrombosis were fracture; fracture group statistics the thrombus, suffering from pulmonary embolism according to the risk level of each fracture group had lower extremity deep venous thrombosis were divided into high risk of thrombosis ( The above person vein and vein) and low risk of people (people, following venous thrombosis) on the fracture group of thrombosis in the high, low risk distribution of thrombosis. Results: whether there are differences in correlation between thrombosis and lateral fracture side, the formation of LE DVT in patients with a total of 127 cases of fracture, including 73 cases of left lower extremity fracture, 54 cases of patients with right lower extremity fractures; 122 cases with unilateral lower limb, 5 cases involving the lower extremities, involving a total of 132 unilateral lower extremity, which left lower limb thrombosis in 72, right lower limb thrombosis at 60; 119 occurred in 13 fractures of ipsilateral, contralateral.LEDVT were more prone to fracture in the same the side (P0.05), left and right side of thrombosis and no significant difference in the distribution of the distribution of left and right sides of fracture (P0.05), left and right side and distribution in patients with lower limb fractures occurred in LEDVT and LED VT in patients with thrombosis of the overall lateral distribution is different in each group (P0.05); fractures in patients with ankle fracture group With two D- dimer level (1.81 3.20mg/L) and the incidence of thrombosis (0.4%) was lower than that of other groups (leg fracture group: 3.70 3.95mg/L, 3.4%, knee fracture group: 4.26 6.18 mg/L, 6.6%, femoral fracture group: 4.49 mg/L 6.08, 5.1%, 4.93 proximal femoral fracture group: 5.99 mg/L, 5.8%), and the difference was statistically significant (P0.05), while the remaining fracture group between two D- dimer levels and the incidence of thrombosis showed no difference statistically significant (P0.05); in the fracture group thrombosis, knee fracture group found statistical distribution of thrombosis in low risk, high risk of thrombosis group and fracture of femur shaft fractures of the proximal group shares proportion was 66.7%, 68.2%, 61.3%, were higher than that of leg fracture group of 25.9% (P0.05), and knee femoral shaft, high risk of thrombosis and proximal femoral fracture group the proportion of the difference was not statistically significant (P0.05). Conclusion: the occurrence of thrombosis after lower limb fracture. Is more likely to happen On the same side of the fracture, no significant difference between the distribution of left and right side of the two; the level of D-dimer and the incidence rate of thrombosis was higher than that of the other group and low group of patients with D- fracture of ankle fracture; knee, femur, proximal femoral fractures in patients with high incidence of thrombosis, and pulmonary embolism in high risk people and vein the above vein thrombosis.

【学位授予单位】：江苏大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R683

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