Prospective Study On Occurrence Regularity And Risk Factors Of Deep Venous Thrombosis In Patients With Hip Fracture

Objective: To study the time course,incidence,incidence characteristics,outcome of D-dimer and the diagnostic value of D-dimer in patients with hip fracture,and to explore the risk factors of deep vein thrombosis in patients with hip fracture.Methods: Prospective cohort study was conducted to collect clinical data of patients with hip fractures within 24 hours of injury from September 2017 to March 2019 in the Department of Bone Trauma of the Affiliated Red Cross Hospital of Xi'an Jiaotong University School of Medicine in strict accordance with the inclusion and exclusion criteria..Patients were treated with intravenous color Doppler ultrasonography of the lower extremities every 24 hours from the day of admission to the hospital.The number of cases of thrombosis,the distribution of thrombus time,the outcome of thrombosis,the occurrence of thrombosis in different fracture sites,and the location of anatomical distribution of thrombus were recorded.Collect and record basic patient information,fractures,surgical conditions,and related laboratory tests.After admission,the risk of bleeding was assessed.Patients without anticoagulation contraindications were given low molecular weight heparin and mechanically treated with plantar venous pump.SPSS 19.0 statistical software was used to statistically analyze the number of new thrombosis cases from post-injury to discharge,and the frequency distribution map was drawn to confirm the time axis of thrombosis.The receiver operating characteristic curve(ROC)was plotted for D-dimer at different time points,and the area under each curve was analyzed.To study the diagnostic value of D-dimer at different time points for DVT.First,the risk factors related to univariate analysis were analyzed,and the risk factors with statistically significant differences were included in multivariate logistic regression analysis to explore the independent risk factors of DVT in patients with hip fracture.Results: A total of 220 patients who met the inclusion criteria were enrolled in the study,and 35 patients withdrew from the study due to lack of surgery or poor compliance.A total of 185 patients completed the experimental study.Among the 185 patients,62 were male and 123 were female.The ratio of male to female was 0.5:1;the age was 18-94 years old,and the average age was 71.97±15.21 years old.Eighty-three patients with femoral neck fractures;97 patients with intertrochanteric fractures;and 5 patients with femoral subtrochanteric fractures.Of the 185 patients,103 had DVT,and the incidence of DVT was 55.68%.The incidence of DVT in different fracture sites: the incidence of DVT in femoral neck fracture was 53.01%(44/83),the incidence of DVT in femoral intertrochanteric fracture was 58.76%(57/97),and the incidence of DVT in femoral subtrochanteric fracture was 40.%(2/5).On days 1,2,3,4,and 5 after injury,the number of thrombosis on the 1st,2nd,3rd,4th,5th,and 6th postoperative days was 26(25.24%)and 10(9.71%),respectively.4 cases(3.88%),3 cases(2.91%),3 cases(2.91%),36 cases(34.95%),13 cases(12.62%),4 cases(3.88%),1 case(0.97%),2 Example(1.94%),1 case(0.97%).The high incidence of DVT is within 2 days after injury and within 2 days after surgery.Of the 103 patients with DVT,90(87.37%)had distal thrombus,4(3.88%)had proximal thrombus,and 9(8.73%)had mixed thrombus.Thrombosis outcomes after anticoagulant therapy: 39 patients(37.86%)had unilateral to bilateral thrombosis,7(6.80%)thrombus disappeared,and 4(3.88%)thrombus changed from distal to proximal(1 case)Pulmonary embolism),2 cases(1.94%)changed from proximal to distal,and 51(49.51%)did not change.The results of ROC curve showed that the area under the D-dimer curve was 0.630,0.565,0.609,0.529,and 0.565,respectively,1 day after injury,1 day before surgery,1 day after surgery,3 days after surgery,and 5 days after surgery.The area under the curve at different time periods is less than 0.7.It is considered that the D-dimer has limited diagnostic value for the diagnosis of DVT in patients with hip fracture.Univariate statistical analysis showed that there was a significant difference in the incidence of DVT between the groups of age,gender,BMI,operative time,blood transfusion,and injury to surgery time.The difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that age ?70 years,BMI ?25kg/m2,operative time ?2 hours,blood transfusion,and injury to operative time ?5 days were independent risk factors for DVT in hip fracture patients.Conclusion: The incidence of DVT in patients with hip fracture is 55.68%.Even if the patient is given prophylactic anticoagulant therapy after admission,the incidence of DVT is still high.The peak time of DVT in patients with hip fracture was 2 days after injury and 2 days after surgery and was mainly caused by distal intramuscular venous thrombosis.The incidence of DVT was different in different fracture sites,and the incidence of DVT was the highest in intertrochanteric fractures.There was no significant change in thrombus after conventional anticoagulation therapy for DVT,and even some of the thrombosis changed from one side to two sides.D-dimer has limited diagnostic value for the diagnosis of DVT in patients with hip fracture.It is necessary to combine the lower extremity venous ultrasonography to diagnose DVT early.Age ? 70 years,BMI ? 25 KG / m2,operative time ? 2 hours,injury to surgerytime ? 5 days,blood transfusion is an independent risk factor for DVT in patients with hip fracture.Clinically,the above risk factors need to be highly alert to the occurrence of venous thrombosis,and the screening and prevention of thrombosis should be emphasized,thereby reducing the incidence of DVT in patients.