髋臼骨折术后下肢深静脉血栓形成的多因素分析

目的 分析影响髋臼骨折术后下肢深静脉血栓形成(DVT)的危险因素.方法 对102髋臼骨折术后DVT发生情况进行分析.术前及术后7～10d均用彩色多普勒检查双下肢深静脉血流通畅情况及DVT的发生,并对11项临床因素与人工关节置换术后DVT形成的相关性进行分析.结果 髋臼骨折术后发生DVT有18例,DVT发生率为17.65%(18/102).经Logistic多因素回归分析,与DVT相关的因素有6个,其中年龄、肥胖、静脉曲张及手术方式使术后发生DVT的风险分别增加到4.075、7.803、46.176和4.251倍(P＜0.05);硬膜外麻醉和踝泵练习使术后发生DVT的风险减少到0.121和0.114倍(P＜0.01).结论 年龄和肥胖是人工关节术后发生DVT的危险因素,而硬膜外麻醉和踝泵练习则是术后发生DVT的保护因素.髋臼骨折术后无症状DVT的大量存在,提示术后最好常规行双下肢彩色多普勒检查,一旦有DVT发生,及时治疗,防止发生致命性肺栓塞.

Risk Factors for Deep Vein Thrombosis after Operations for Acetabular Fractures

Objective To analyze the clinical risk factors for deep vein thrombosis(DVT)after operations for acetabular fracture.Methods The data of 102 patients with acetabular fracture undergoing operations at our center were reviewed.All patients received low-molecular-weight heparin preoperatively and for 7 days postoperatively to prevent DVT.Color Doppler ultrasonography was used to detect DVT of bilateral lower extremities in all patients before operation and on the postoperative 7 to 10 day.Eleven clinical factors were examined preoperatively and on the postoperative 7 to 10 day in order to analyze their influences on DVT formation after surgery.Results DVT occurred in 18 patients after operation.The incidence of DVT in all patients was 17.6%(18/102).There were more asymptomatic DVT cases(56%,10/18)than symptomatic ones.Logistic regression analysis demonstrated a definite association of age,obesity(representative by body mass index),varicose vein,operation method,anesthesia method,ankle-pump training with odds ratio of 4.075,7.803,46.176,4.251,0.121 and 0.114 respectively.Other clinical factors had no statistically significant association with DVT.Conclusion Age,obesity,varicose vein,and operation method are the risk factors for DVT after operations for acetabular fractures while extradural anesthesia and ankle-pump training are the protecting factors for DVT after operations for acetabular fractures.