Study On The Regularity And Clinical Treatment Of Deep Venous Thrombosis In Closed Pilon Fracture

Objective: To investigate the regularity and clinical treatment of deep venous thrombosis in closed Pilon fractures.Methods: To retrospectively analyze the data of inpatients with Pilon fractures of the lower extremities admitted from September 2014 to September 2017 in the Department of Orthopedics,Xi'an Honghui Hospital.According to the inclusion and exclusion criteria,the data of the eligible patients including the inclusion criteria were collected,including age,gender,body mass index(BMI),comorbidities,cause of injury,preoperative traction,fracture classification,preoperative waiting time,anesthesia(ASA)grade,RAPT score,duration of surgery,tourniquet time,surgery in the amount of input,perioperative blood loss,preventive treatment,hospitalization and laboratory examinations after postoperative review,and venous ultrasound results of both lower limbs.All patients were assessed for thrombosis risk after admission,low-risk group was treated with mechanical treatment of plantar vein pumps,LMWH was given after exclusion of contraindications to anticoagulation,and mechanical treatment with plantar vein pump was added to 1d preoperatively.After the drainage tube was removed,the patient was continued to use medication.During the hospitalization period,the patient's platelet count was monitored,and the coagulation series was regularly reviewed.The preoperative ultrasound showed a proximal or mixed thrombus,and a retrievable inferior vena cava filter(IVCF)was placed before orthopedic surgery.Using SPSS19.0 software to establish the database of the data,after the assignment of relevant variables for statistical analysis.Results: 145 cases of patients with closed lower extremity Pilon fractures were included.There were 88 males and 57 females,and the sex ratio was 1.5:1;the age ranged from 19 to83 years and the average age was 46.3±14.3 years.There were 24 cases of type B3,27 cases of type C1,34 cases of type C2,and 60 cases of type C3.The incidence of DVT in 145 patients with closed lower Pilon fractures was 28.3%.The incidence of preoperative DVT was 20.0%.The incidence of postoperative DVT was 23.4%.The incidence of DVT before and after surgery was statistically significant(P=0.000).DVT involving the left lower extremity and the distal asymptomatic myenteric vein preoperatively and postoperatively.The incidence of preoperative DVT on uninjured limb was 6.2% and the incidence of postoperative DVT on uninjured limb was 7.6%;18 new cases of DVT,8 cases of disappeared DVT,and 119 cases of no change during hospitalization;the incidence of DVT after 1 month 8.3%,compared with the incidence of postoperative thrombosis,the difference was statistically significant(P = 0.000),The incidence of DVT was 3.8% at 3months after surgery.Compared with the incidence of thrombosis at 1 month after surgery,the difference was statistically significant(P=0.003).At the time of review,DVT was associated with asymptomatic left lower extremity.mainly between muscular vein,not involving the proximal.all patients had no fatal PE during treatment and follow-up;DVT group gender,age,fracture classification,preoperative waiting time,high-risk group perioperative There was a statistically significant difference in blood loss and preoperative traction compared with non-DVT group(P<0.05).Multivariate logistic regression analysis showed that age between 40 and 59,C3-type fracture,and preoperative waiting time 5-9days were closed Pilon fractures.Independent risk factors for DVT;1 day before surgery and 3 days after surgery,both groups D-D the difference in D concentration was statistically significant(P<0.05).There was no significant difference in D-D and Fib between the time of admission,preoperative 1d Fib,and postoperative 1 and 5 d(P>0.05).The DVT group had a correlation between D-D and Fib on the third postoperative day,and ?0.5<|r|?0.8,suggesting a moderate correlation between D-D and Fib.(r=0.694 P=0.019);ROC curve results show that when the DD diagnosis threshold is 4.63mg/L,the maximum AUC is 0.779,the 95%confidence interval is 0.690 to 0.868,the sensitivity is 61.0%,and the specificity is 87.5%.Conclusion:The incidence of DVT in perioperative patients with Pilon fracture was 28.3%.The incidence of DVT was 8.3% and 4.8% at one month and three months after operation.DVT involving the uninjured limb should not be neglected;In the left lower extremity,distal intermuscular venous thrombosis was predominant.One-month and three-month postoperative DVT included the intermuscular venous thrombosis of the left lower extremity.Age,C3-type fracture,preoperative waiting time 5-9 days and high-risk group were closed Pilon The risk factors for DVT were independent risk factors.When DD was4.63 mg/L,the specificity and sensitivity to DVT were better.DVT prevention and screening of patients with lower extremity fracture during hospitalization can effectively reduce the incidence of DVT.