Analysis Of Risk Factors For Preoperative Deep Venous Thrombosis Of Lower Extremities In Patients With Hip Fractures

Objective:Hip fracture mainly including femoral neck fracture and intertrochanteric fractures.Even after hip fractures are prevented by anticoagulant drugs such as LMWH,deep vein thrombosis is still often formed in lower limbs,while pulmonary embolism(PE)and deep vein dysfunction in lower limbs can be caused by the removal of deep vein thromboembosis and the inflow of pulmonary artery.Through retrospective analysis,To study the incidence and risk factors of preoperative venous thrombosis in lower limbs in patients with hip fracture,and the effectiveness of Caprini thrombosis assessment scale in patients with hip fracture,so as to provide a reference for the prevention of preoperative venous thrombosis in patients with hip fracture in the future.Methods:Data of 242 patients with hip fracture admitted the second affiliated hospital of anhui medical university from January 2017 to December 2018 were retrospectively analyzed,including 99 males and 143 females,with an average age of69.1 years(15-96 years).There were 189 cases of femoral neck fracture and 53 cases of intertrochanteric fracture.Blood vessel color ultrasonography was performed in both lower extremities.According to the results,the patients were divided into the lower extremity venous thrombosis group and the lower extremity non-venous thrombosis group(lower extremity patients with deep venous thrombosis were preoperatively implanted with lower lumen filter).Of patients Caprini score,age,sex,fracture type(femoral neck fracture and intertrochanteric fractures),injury to the operation time,laboratory tests(RBC hematocrit and fibrinogen,D-dimer,hemoglobin),merging,chronic diseases(hypertension,diabetes)may thrombosis risk factor of single factor analysis,then using multiariable Logistic regression analysis to determine the independent risk factors,the ROC curve drawing Caprini rating scale curve.Results:Of the 242 patients with hip fractures,58(23.97%)developed deep venous thrombosis in the lower extremities.There was no significant difference in gender,fracture type,d-dimer,fibrinogen,or chronic disease(hypertension,diabetes)between the lower extremity venous thrombosis group and the lower extremity non-venous thrombosis group(P>.05).The age,operation time and hemoglobin level of the two groups were statistically significant(P<0.05).Multivariate regression analysis showed that age ≥70 years and duration from injury to surgery ≥5d were independent risk factors for venous thrombosis in patients with hip fracture.Caprini scores in the lower extremity venous thrombosis group were higher than those in the lower extremity non-venous thrombosis group,and univariate analysis between the two groups showed statistical significance(P<0.05).Further analysis of the ROC curve showed that the AUC of the ROC curve was 0.620.When the youten index(sensitivity +specificity-1)reached its maximum,the best critical value of Caprini score was 7.When the Caprini score ≥7,the sensitivity and specificity of the predicted deep venous thrombosis of the lower extremity was 89.7% and 79.3%.Conclusion:Patients with hip fracture are prone to developing deep vein thrombosis even when treated with preventive anticoagulant drugs.Among them,elderly patients and longer waiting time before surgery are the risk factors for thrombosis.Caprini thrombosis assessment scale has certain significance in predicting DVT in patients with hip fracture.