| Objective: 1.To explore the characteristics of perioperative DVT in patients with traumatic lower limb fracture: incidence,time regularity,limb vein distribution,the outcome of DVT in different anticoagulation groups.2.The risk factors related to the formation of DVT were analyzed.Methods: according to the inclusion and exclusion criteria,a prospective cohort study was conducted to select 409 patients who were hospitalized in Department of Orthopaedic Surgery,Hong Hui Hospital,Xi'an Jiao tong University from September 2017 to December 2019.According to the results of the first lower limb vein ultrasound(the first ultrasound was completed within 24 hours after admission),all the patients were divided into DVT group and non-DVT group,and the non-DVT group was subdivided into pure physical prevention group and prophylactic anticoagulation group.Patients were examined by lower limb vein ultrasound every 24 hours from admission to discharge.Prophylactic anticoagulation group was given prophylactic dose of low molecular weight heparin and plantar vein pump physical prophylaxis,physical prophylaxis group was only given plantar vein pump physical prophylaxis,DVT group was given therapeutic dose of low molecular weight heparin and stopped plantar vein pump prophylaxis at the same time,all anticoagulant patients stopped using anticoagulants from 12 hours before operation to 12 hours after operation.The information of sex,age,fracture type,complicated with medical diseases and other site injuries,body mass index,time from admission to operation,anesthesia grade,operation time,perioperative blood loss,perioperative blood transfusion,intraoperative transfusion,reduction,internal fixation,hemoglobin,D-dimer and venous ultrasound results of both lower extremities were collected and analyzed by SPSS22.0 statistical software.Results: 1.A total of 409 patients completed the study,including 173 males and 236 females,with an average age of 63.46 ±18.50 years old.The total incidence of DVT was 52.32%,and the incidence of DVT before and after operation was 34.23% and 48.41% respectively,and the difference was statistically significant(P<0.05).The DVT incidence of hip fracture,femoral shaft fracture,knee joint fracture,tibia and fibula fracture,foot and ankle fracture was 59.41%,52.63%,52.83%,38.71% and 8.57% respectively,the difference was statistically significant(P <0.05).2.The cases of DVT appeared on the 1st,2nd,3rd,4th,5th and 6th day after injury were 31,53,32,9,10 and 5 respectively.The number of cases appearing on the 1st,2nd,3rd and 4th day after operation was 41,20,9 and 4 respectively.The peak period was within 3 days after injury and within 2 days after operation.The change curve of DVT showed a bimodal shape,and the change trend of DVT in each part of the fracture was basically consistent with the overall change trend;3.The proportion of proximal,mixed and distal thrombus was 1.40%,3.27% and 95.33%,respectively.Proximal thrombus and mixed thrombus all occurred in hip fracture,femoral shaft fracture and knee joint fracture.Distal thrombus accounted for the highest proportion(95.33%).Intermuscular vein thrombosis was the main thrombus in the distal thrombus.4.The incidence of DVT in pure physical prevention group and preventive anticoagulation group was 52.78% and 38.78% respectively,and the difference was statistically significant(P<0.05).The disappearance rate of DVT in pure physical prevention group,preventive anticoagulation group and therapeutic anticoagulation group was 2.63%,4.90% and 13.51% respectively,and the difference was statistically significant(P <0.05);5.Univariate analysis showed that age,sex,perioperative blood transfusion and blood loss,ASA score,fracture reduction mode,HGB decrease,positive D-dimer 1 day after operation,diabetes,coronary atherosclerotic heart disease,cerebral infarction,more than two kinds of medical diseases and fracture site were the risk factors of DVT.Multivariate analysis showed that age,type of fracture(hip,femoral shaft,around knee joint),positive D-dimer 1 day after operation,ASA score(3)and decreased HGB?50g/L were independent risk factors for DVT.Conclusion: 1.The overall incidence of DVT in patients with traumatic lower limb fracture was 52.32%,which was significantly higher than that before operation,and the incidence of DVT in different fracture sites was quite different,so targeted prevention and treatment should be taken;2.The high incidence period of DVT was within 3 days after injury and 2 days after operation,and the time change curve of DVT was bimodal,and the time change rule of each site was basically consistent with the overall change trend.3.The highest proportion of distal thrombosis was intermuscular venous thrombosis,and proximal thrombus was more likely to occur in hip fracture,femoral shaft fracture and knee joint fracture;4.The incidence of DVT in the pure physical prevention group was significantly higher than that in the preventive anticoagulation group,and the disappearance rate of DVT in the therapeutic anticoagulation group was the highest among the three groups.Anticoagulation is effective and necessary;5.Age,fracture site,ASA score(3),HGB decreased?50 g/L,and positive D-dimer 1 day after operation were independent risk factors of DVT,and more attention should be paid to the above risk factors. |
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