老年创伤骨折患者伤情特点及血栓形成的危险因素
作者:
作者单位:

(海南西部中心医院骨科,儋州 571799)

作者简介:

通讯作者:

中图分类号:

R683; R592; R543.6

基金项目:


Injury characteristics and risk factors of thrombosis in elderly patients with traumatic fracture
Author:
Affiliation:

(Department of Orthopedics, Hainan West Central Hospital, Danzhou 571799, China)

Fund Project:

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 文章评论
    摘要:

    目的 探讨老年创伤骨折患者伤情特点及深静脉血栓(DVT)形成的危险因素。方法 选取2012年1月至2016年6月海南西部中心医院收治的老年创伤骨折患者1046例,根据术后1周内是否发生DVT分为两组:DVT组(n=132)和非DVT组(n=914)。采用SPSS 17.0软件进行数据分析。根据数据类型分别采用t检验或χ2检验进行组间比较。采用单因素及多因素logistic回归分析创伤骨折患者发生DVT的相关危险因素。应用ROC曲线评估术前D-二聚体、纤维蛋白原(FIB)和C-反应蛋白(CRP)水平预测DVT发生的价值。结果 1046例老年创伤骨折患者,跌倒伤是首位致伤原因,占20.9%(219/1046),DVT的总发生率为12.6%(132/1046),临床表现以患肢肿胀、浅静脉曲张、疼痛和压痛为主。单因素筛选出有统计学意义的因素进行多因素logistic回归分析显示,年龄≥70岁(OR=2.725,95%CI 1.842~4.027)、高血压(OR=1.584,95%CI 1.163~2.158)、坠落伤(OR=3.142,95%CI 2.106~4.685)、髋骨骨折(OR=2.847,95%CI 1.875~4.326)、粉碎性骨折(OR=2.054,95%CI 1.463~2.884)、≥3处骨折(OR=2.162,95%CI 1.572~2.976)、骨折后休克(OR=3.063,95%CI 2.074~4.527)、手术时间≥2 h(OR=2.151,95%CI 1.518~3.046)、D-二聚体≥3.5 mg/L(OR=2.396,95%CI 1.668~3.442)、FIB≥6.0 g/L(OR=1.638,95%CI 1.274~2.106)及CRP≥26.0 mg/L(OR=1.084,95%CI 1.012~1.468)是老年创伤骨折患者发生DVT的独立危险因素。D-二聚体[曲线下面积(AUC)=0.736,95%CI 0.672~0.806]的最佳阈值为3.25 mg/L时,灵敏度和特异度分别为87.2%和58.3%;FIB(AUC=0.682,95%CI 0.617~0.754)的最佳阈值为5.84 g/L时,灵敏度和特异度分别为78.5%和62.5%;CRP(AUC=0.705,95%CI 0.635~0.783)的最佳阈值为26.73 mg/L时,灵敏度和特异度分别为81.3%和55.2%。结论 老年创伤骨折患者DVT发生率较高,影响DVT发生的危险因素较多,应针对高危人群采取预防措施以减少DVT的发生。

    Abstract:

    Objective To explore the injury characteristics in elderly patients with traumatic fracture and investigate the risk factors for deep vein thrombosis. Methods A total of 1046 elderly patients with traumatic fracture admitted in our hospital from January 2012 to June 2016 were enrolled in this study. According to the occurrence of deep vein thrombosis (DVT) within 1 week after operation, they were divided into DVT group (n=132) and non-DVT group (n=914). Clinical data were analyzed by SPSS statistics 17.0. The differences were compared by t test or Chi-square test respectively. Univariate and multivariate logistic regression analysis was used to analyze the risk factors of DVT in traumatic fracture patients. Preoperative D-dimer, fibrinogen (FIB) and C-reactive protein (CRP) levels were assessed for predictive value of DVT by using receiver operating characteristic (ROC) curve. Results Among the 1046 elderly patients, the top cause of injury was falling (20.9%,219/1046) and the incidence of DVT was 12.6% (132/1046). The main manifestations were limb swelling, varicosis, pain and tenderness. The statistically significant factors screened by single factor analysis were further analyzed by multivariate logistic regression analysis, and the results showed that ≥ 70 years old (OR=2.725, 95%CI 1.842-4.027), hypertension (OR=1.584,5%CI 1.163-2.158), falling injury (OR=3.142,5%CI 2.106-4.685), hip fracture (OR=2.847,5%CI 1.875-4.326), comminuted fracture (OR=2.054,5%CI:1.463-2.884), at least 3 fractures (OR=2.162, 95%CI 1.572-2.976), post fracture shock (OR=3.063,5%CI:2.074-4.527), operation time over 2 h (OR=2.151, 95%CI 1.518-3.046), D-dimer ≥3.5 mg/L (OR=2.396,5%CI:1.668~3.442), FIB ≥6.0 g/L (OR=1.638, 95%CI:1.274-2.106) and CRP ≥26.0 mg/L (OR=1.084,5%CI 1.012-1.468) were independent risk factors for DVT in senile patients after traumatic fracture. When the optimal threshold of D-dimer was 3.25 mg/L area under the curve (AUC)=0.736, 95%CI 0.672~0.806], the sensitivity and specificity were 87.2% and 58.3%, respectively. When FIB had the optimal threshold of 5.84 g/L (AUC=0.682,5%CI 0.617-0.754), the sensitivity and specificity were 78.5% and 62.5%, respectively. When CRP had the optimal threshold of 26.73 mg/L (AUC=0.705,5%CI 0.635-0.783), the sensitivity and specificity were 81.3% and 55.2%, respectively. Conclusion The incidence of DVT is quite high in the elderly patients with traumatic fracture. Since there are many risk factors for DVT, preventive measures should be taken to reduce the occurrence of DVT in high-risk groups.

    参考文献
    相似文献
    引证文献
引用本文

张恒林,谢文凯,羊才丰,蒋家正.老年创伤骨折患者伤情特点及血栓形成的危险因素[J].中华老年多器官疾病杂志,2017,16(9):677~681

复制
分享
文章指标
  • 点击次数:
  • 下载次数:
  • HTML阅读次数:
  • 引用次数:
历史
  • 收稿日期:2017-05-05
  • 最后修改日期:2017-06-30
  • 录用日期:
  • 在线发布日期: 2017-09-26
  • 出版日期: