下肢骨折术前深静脉血栓的发生与D-二聚体动态变化的相关性研究

发布时间：2018-06-20 22:26

本文选题：下肢骨折 + 深静脉　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:本课题只回顾性研究我院下肢单一部位闭合性骨折患者术前深静脉血栓的发生率,分析下肢骨折术前深静脉血栓的发生与D-二聚体动态变化的相关性研究。方法:回顾性分析山西大医院2011年11月到2013年12月下肢骨折患者的临床资料:体重指数、术前卧床时间、骨折后早期(3d)及术前长时间卧床(7d)监测D-二聚体结果、下肢深静脉超声检查的结果等。依据所有纳入病例的术前下肢深静脉超声检查结果,统计我院下肢单一部位闭合性骨折患者术前深静脉血栓的发生率,并依据术前超声结果将纳入患者分为非DVT组与DVT组,并对两组间骨折后24h内的D-D检查结果、术前D-D峰值、D-D峰值出现时间等指标进行统计分析和比较。P0.05为差异有统计学意义。结果:(1)下肢单一部位闭合性骨折患者术前卧床超过7天的DVT发生率要高于卧床少于7天的DVT发生率,且差异具有统计学意义(P0.05)。(2)DVT组与非DVT组在伤后24h内,D—二聚体含量比较差异显著有统计学意义(P0.05),但是DVT组与非DVT组之间的D—二聚体峰值比较差异无统计学意义。(3)骨折后前3d内,非DVT组D—二聚体达到峰值的患者比例明显高于DVT组,且差异具有统计学意义(P0.05)。(4)下肢单一部位闭合性骨折患者术前深静脉血栓发生的相关危险因素分析结果如下:卧床时间7天、骨折后早期(3d)凝血检查中D-二聚体连续性增高,不出现下降趋势即峰值出现较晚的患者发生深静脉血栓的风险明显增大;年龄、性别、BMI、入院诊断等对下肢单一部位闭合性骨折患者术前深静脉血栓发生的影响不显著。结论:1.山西大医院骨科下肢单一部位闭合性骨折患者深静脉血栓(LDVT)发生率为17.8%。2.术前长时间卧床(7d)和早期(3d)D-二聚体动态连续升高,为下肢单一部位闭合性骨折患者术前DVT发生的危险因素。3.不同类型骨折术前LDVT发生率不相同,其中股骨颈骨折深静脉血栓的发生率最高、为35.71%,但是差异没有统计学意义。4.单次D-D检测不足以判断LDVT的形成;D-D连续检测判断LDVT可能成为一种趋势。
[Abstract]:Objective: to study the incidence of deep venous thrombosis (DVT) in patients with closed fracture of lower extremity in our hospital, and to analyze the correlation between DVT and dynamic changes of D-dimer. Methods: the clinical data of patients with lower extremity fracture from November 2011 to December 2013 in Shanxi Great Hospital were retrospectively analyzed. Body mass index (BMI), bedrest time before operation, early period after fracture (3 days) and prolonged bedrest before operation (7 days) were analyzed to monitor the results of D-dimer. Results of ultrasound examination of deep vein of lower extremity. The incidence of preoperative deep venous thrombosis in patients with closed fracture of lower extremity in our hospital was counted according to the results of preoperative deep vein ultrasound examination in all patients. According to the results of preoperative ultrasound, the patients were divided into non-DVT group and DVT group. The results of D-D examination within 24 hours after fracture between the two groups, the time of D-D peak and D-D peak before operation were statistically analyzed and compared. P05 was statistically significant. Results (1) the incidence of DVT in patients with closed fracture of single part of lower extremity was higher than that in patients who stayed in bed for more than 7 days before operation. There was significant difference in D- dimer content between DVT group and non-DVT group within 24 hours after injury, but there was no significant difference between DVT group and non-DVT group in D- dimer peak value within 3 days after fracture. The proportion of patients with peak D-dimer in non-DVT group was significantly higher than that in DVT group. The risk factors of deep venous thrombosis in patients with single closed fracture of lower extremity were analyzed. The results were as follows: 7 days stay in bed, 3 days after fracture) the continuity of D-dimer was increased in coagulation examination. The risk of deep venous thrombosis in patients with late peak value was significantly increased, while age, sex, and admission diagnosis had no significant effect on the occurrence of deep venous thrombosis in patients with closed fracture of lower extremity at single site before operation. Conclusion 1. The incidence of deep venous thrombosis (LDVT) in patients with closed fracture of lower extremity in orthopaedic department of Shanxi Great Hospital was 17.8%. Prolonged preoperative bed rest for 7 days) and early dynamic elevation of D-dimer were risk factors of DVT in patients with closed fracture of lower extremity. The incidence of LDVT in different types of fractures was different before operation, and the incidence of deep vein thrombosis in femoral neck fracture was the highest (35.71%), but the difference was not statistically significant. 4. The single D-D detection is not enough to judge the formation of LDVT. It may be a trend to judge LDVT by D-D continuous detection.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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