Deep Vein Thrombosis Occurred Characteristics And Variation Of D-dimer

Part ? Analysis on risk factors for deep vein thrombosis in patients wi th traumatic fractures.Objective:To explore the risk factors contributing to deep vein thrombosis(DVT)in the orthopaedic surgery perioperative period.Methods:All of 589 cases of surgical treatment were involved in this study,and the general situation of the patients,fracture,operation and related laboratory tests were recorded and performed statistical analysis.Result:The total incidence rate of DVT in 589 patients was 11.99%.The univariate analysis showed that male patients with age>65 years?body mass index(BMI)?25 kg/m2,history of smoking,lack of exercises,history of diabetes hypertensive patientshave a higher incidence of thrombosis,and the incidence of DVT was significantly increased in patients with a large amount of blood transfusion and general anesthesia during >2 hours.In different injury types,The incidence of lower extremity venous thrombosis was different in different parts of fracture patients.The incidence of DVT in patients with multiple fractures was higher than that in patients with single fractures.Fibrinogen,D-dimer and C-reactive protein were significantly increased in patients with thrombosis.The time of high incidence of thrombosis in patients was 1-3 days and 1 days after operation.The incidence of thrombosis increased with age.Conclusions:DVT in traumatic fracture there is a high incidence of patients,the incidence of DVT and the general condition of patients,trauma,surgery and other related factors and laboratory indicators,clinicians need to be vigilant and take preventive measures as soon as possible.Part ? Incidence of deep vein thrombosis and D-dimer in patients with intertrochchanteric fractureObjective:To investigate the factors associated with the incidence of deep vein thrombosis(DVT)and D-dimer in the patients with intertrochchanteric shaft fracture.Methods:Enrolled in the study were 156 patients with intertrochchanteric fracture who had been treated from september 2014 to 2016.They were grouped according to the presence or absence of DVT.The D-dimmer levels and Vascular Doppler ultrasound were examined for all the cases at the first day after trauma,the day before surgery,1st,3rd,5th,7th and 14 th postoperatively.Additional,the Vascular Doppler ultrasound were examined at third day after trauma.All of the result is true and accurate records.Result:In this cohort,DVT occurred in 22 cases.9 occurred before surgery(5.76 %),The postoperative DVT was new found in 13 cases(8.33%).Thrombosis occurs is the peak time to postoperative 1 day after injury.Significant differences of D-dimer level were detected between the two group(F=3.989,P=0.048<0.05),DVT group's value was higher than the NDVT's.At different time points,the difference between the two groups was statistically significant after 3rd postoperatively.D-dimer values were affected by the time variation(F = 104.22,P <0.01),The D-dimer in the DVT group was 4.18 ± 3.16?g / ml on the first day after injury,3.31 ± 2.53?g / ml before the day of operation,and 5.91 ± 3.77?g / ml on the first day,4.49 ± 2.58?g / ml on the third day,5.49 ± 2.93?g / ml at 5th days,4.91 ± 3.32?g / ml on day 7th and 3.55 ± 2.23?g / ml at 14 th days after operation.The changes of D-dimer in the NDVT group were 3.94 ± 2.90?g / ml on the first day after injury,2.71 ± 2.39?g / ml before the day of operation and 4.68 ± 3.37?g / ml on the 1st day after operation,2.98±2.03?g / ml on the third day,3.82±2.70?g / ml at 5th days,3.45±2.66?g / ml on day 7th and 2.12±1.61?g / ml at 14 th days after operation,and the peak appeared on the first day after operation.The area under the curve of D-dimer at different time points was analyzed by ROC curve.The area under ROC curve was between 0.7 and 0.9 after 14 days of surgey.The accuracy of diagnosis was moderate.The threshold was 2.61?g / ml,the sensitivity was 68.2%,the specificity was 78.9%?Conclusions:1 Femoral intertrochanteric fractures in patients with perioperative high incidence of thrombosis,predilection site for the lower extremity intramuscular vein,thrombosis peak time for 1-3 days after injury and 1 day after surgery.2 D-dimer peak time at 1 day after surgery,and same with thrombosis the second peak time.3 The dynamic monitoring of D-dimer after trauma has certain diagnostic value for venous thrombosis of lower extremity.The accuracy of postoperative D-dimer is moderate at 14 days after operation,and the critical value is appropriate as 2.61 ug / ml.