| Background:The closed proximal tibial fracture has large injury energy,complex fracture mechanism,diverse anatomical structure changes and difficult operation.A detailed and complete operation plan needs to be formulated before operation.At the same time,the nerve and blood vessels around the knee joint are abundant,and the soft tissue swelling after injury is more serious.After the proximal tibial fracture,the peripheral blood vessels and the distal blood vessels of the limb often have slow blood flow due to the immobilization and swelling of the affected limb,which is easy to generate popliteal vein thrombosis,tibial vein thrombosis,intramuscular vein thrombosis,etc,which has a serious impact on the prognosis of patients.This is one of the common complications after fracture surgery,and the thrombus moves with the blood flow to form pulmonary embolism Cerebral embolism and other serious complications.It not only affects the fracture healing,but also endangers the patient’s own safety.Therefore,monitoring and early intervention of deep vein thrombosis in patients with closed proximal tibial fractures during perioperative period by using thromboelastogram is a good way to solve the above problems.Using this test to monitor,guide and intervene can effectively evaluate the hypercoagulable state of patients,prevent and reduce the incidence of deep vein thrombosis,making this new detection method quickly become a hot spot in this field.Objection:For the patients with closed proximal tibial fractures,the relevant values that affect thrombosis after fracture surgery are regularly monitored with the help of thromboelastogram detection technology,and then the effect of intervention on deep vein thrombosis in patients with closed proximal tibial fractures during perioperative period is evaluated with thromboelastogram.Thromboelastogram during perioperative period of fracture was monitored by the relevant experimental indicators of laboratory science,and the detection advantage of thromboelastogram in the intervention of thrombosis after fracture operation was further verified.Methods:A retrospective analysis of 80 patients with closed tibial fracture and surgery in the Department of Traumatology and Orthopedics,China-Japan Union Hospital,from September 2021.12 to 2022.12,was carried out.According to the source of the patients,the time of admission,the date of surgery,and the time of discharge,the patients were matched and divided into the control group(n=40)and the observation group(n=40),of which24 were male patients and 16 were female patients in the control group;The age of the patient was(56.13 ± 8.94)years old.There were 23 male patients and 17 female patients in the observation group;The age of the patient was(58.35 ± 7.95)years old.The age,sex and length of stay of the two groups were different;General data,such as fracture types,are not significantly different(P>0.05),and have certain comparability.The operation process was successfully completed.The control group was treated with oral livasaban after operation,and the observation group added TEG detection on this basis,and then continued anticoagulation or antiplatelet therapy after analysis and evaluation.According to the changes of R value and MA value in TEG results,those with R value<5min and/or MA value>65mm were treated with low molecular heparin 1000 U anticoagulation;For patients with MA value>65 mm,low molecular weight heparin anticoagulation,8 h each time;Patients with R value of 5-10 min or MA value>70 mm were treated with antiplatelet therapy.TEG was used to evaluate the R value(coagulation reaction time5.00-10.00 min)and K value(coagulation formation time 1.00-3.00 min)in both groups at 3 days after operation,α Value(thrombin formation rate53.00-72.00 deg),MA value(maximum thrombus amplitude 50.00-70.00mm)and CL value(normal value of coagulation complex index is-3.00-3.00,<-3 indicates low coagulation,>3 indicates high coagulation).And record the patient’s hypercoagulable state and DVT value.Relevant data are mainly analyzed using IBM SPSS Statistics 24.0(IBM Canada Ltd)statistical software.For data conforming to the normal distribution,the measurement data is described by(x ± S)the comparison between the two groups adopts t test,the data of non-normal distribution,the measurement data is described by the median and quartile interval,and the rank sum test is used.Use between two groups of counting data χ2 Inspection.Results The histogram was plotted using Graph Pad Prism 7.00.All data in this study were statistically significant with P<0.05.Result:All operations were successfully completed.Compared with the control group,the R and K values of patients in the observation group were significantly higher(P<0.05).At the same time,the MA value αValue and CL value decreased significantly(P<0.05).The number of patients with hypercoagulability and DVT in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:The thromboelastogram technique was used to evaluate the surgical patients with proximal tibial fracture,and according to the relevant data of the thromboelastogram detection,the corresponding treatment measures were implemented for the patients with different possible risks.For those with R value<5 min and/or MA value>65 mm,the blood of the patients showed a low coagulation state,so based on heparin anticoagulation,and for those with R value 5～10 min or MA value>70mm,the blood showed a high coagulation state,Therefore,antiplatelet therapy should be given in time to prevent venous thrombosis.This study found that the incidence of hypercoagulability and deep venous thrombosis in patients in the observation group was lower than that in the control group,and the R value and K value were higher than those in the control group,suggesting that the coagulation reaction time and coagulation formation time were significantly prolonged in the observation group,but the MA value,α value and CL value decreased significantly,indicating that the maximum reduction of thrombus,the formation of thrombin slowed down,and the blood was in a low coagulation state.The proportion of deep venous thrombosis in the observation group was significantly reduced,and the incidence of high coagulation state and deep venous thrombosis was 2.50% and 0.00%,respectively,and the difference was statistically significant(P<0.05).(1)Thromboelastogram can directly and dynamically reflect the process of blood coagulation and fibrin formation through image,and is used to guide the perioperative blood transfusion,thrombolytic therapy and anticoagulant treatment of fracture patients.However,routine blood coagulation function test can only evaluate a part of blood coagulation function,and cannot comprehensively and accurately reflect the overall bleeding and blood coagulation.Color Doppler ultrasound is an important means to check the deep vein thrombosis of the lower extremity,which can diagnose the disease,but its preventive value is not high,and it is generally checked as a diagnostic means.Therefore,sensitive monitoring indicators are needed for early prevention of deep venous thrombosis of lower limbs.(2)The low sensitivity and high specificity of D-dimer make it more reported in negative prediction.Compared with traditional coagulation indicators,thromboelastogram(TEG)is more dynamic in detecting coagulation function,can better reflect the coagulation process and fibrosis process,and its detection is simpler and faster.(3)Thromboelastogram can predict the occurrence of hypercoagulable state by measuring the relevant key indicators such as coagulation reaction time,coagulation formation time,thrombin formation speed,maximum thrombus amplitude,coagulation comprehensive index,etc.,and carry out early diagnosis,early prevention and early intervention for patients with fracture with risk factors of deep vein thrombosis.(4)Thromboelastogram examination has high accuracy in the diagnosis of hypercoagulable state and deep vein thrombosis in patients with closed proximal tibial fracture.Accurate intervention based on the results of thromboelastogram can reduce the occurrence of deep vein thrombosis in patients after fracture surgery,and also provide clinicians with relevant diagnosis and treatment opinions.Therefore,the use of thromboelastography technology to formulate post-operative monitoring plan has greatly reduced the thrombosis rate of patients,and also ensured the safety of patients.The post-operative monitoring plan has been restored to the maximum in clinical practice. |
PDF Full Text Request