| 脊柱骨折术前下肢深静脉血栓发生率及其危险因素分析 |
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投稿时间：2021-12-18
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| 作者 | Author | 单位 | Address | E-Mail |
| 傲然·马合沙提 |
Aoran·Maheshati |
新疆医科大学第一附属医院综合外科, 新疆 乌鲁木齐 830054 |
Department of General Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang, China |
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| 杨毅 |
YANG Yi |
新疆医科大学第一附属医院综合外科, 新疆 乌鲁木齐 830054 |
Department of General Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang, China |
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| 哈力·哈布力汗 |
Hali·Habulihan |
新疆医科大学第一附属医院综合外科, 新疆 乌鲁木齐 830054 |
Department of General Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang, China |
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| 金格勒 |
Jingele |
新疆医科大学第一附属医院综合外科, 新疆 乌鲁木齐 830054 |
Department of General Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang, China |
docjin81@163.com |
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| 期刊信息：《中国骨伤》2022年，第35卷，第8期，第717-723页 |
| DOI：10.12200/j.issn.1003-0034.2022.08.004 |
| 基金项目:新疆维吾尔自治区科技支疆项目（编号：2020E0285） |
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中文摘要:
目的：探究脊柱骨折术前下肢深静脉血栓（deep vein thrombosis，DVT）的发生率，并分析其危险因素。
方法：对2017年10月至2020年12月接受手术治疗的1 046例脊柱骨折患者的临床资料进行回顾性分析，包括年龄、性别、体质量指数、吸烟史、合并症、骨折至确诊DVT时间、入院时血液指标检测结果，其中并发症包括高血压、骨质疏松、糖尿病、冠心病、慢性阻塞性肺疾病、贫血、肥胖、低钾血症、低钠血症、低蛋白血症、肾功能不全、脊髓损伤；入院时血液指标检测结果包括红细胞比容（hematocrit，HCT），肌酐（creatinine，Cre），甘油三酯（triglyceride，TG），高密度脂蛋白（high-density lipoprotein，HDL），低密度脂蛋白（low-density lipoprotein，LDL），D-二聚体（D-Dimer，D-D），纤维蛋白（原）降解产物（fibrin/fibrinogen degradation products，FDP），C-反应蛋白（C-reactive protein，CRP）。根据患者入院后至手术前下肢静脉超声结果是否诊断DVT进行分组，将发生DVT患者设为DVT组，未发生DVT患者设为非DVT组。先对上述可能危险因素进行单因素分析，再采用多因素Logistic回归分析脊柱骨折术前DVT的危险因素。
结果：1 046例脊柱骨折患者中，术前发生DVT共137例，未发生DVT者909例。两组患者年龄，术前合并骨质疏松、糖尿病、贫血、低蛋白血症以及低密度脂蛋白，血浆D-二聚体，纤维蛋白（原）降解产物，C-反应蛋白水平比较差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，骨质疏松症（OR=3.116，95% CI：1.816-5.346，P<0.001），低蛋白血症（OR=2.508，95% CI：1.583-3.974，P<0.001），术前血清低密度脂蛋白>4.645 mmol/L （OR=2.586，95% CI：1.394-4.798，P<0.001），血浆D-二聚体>558.00 ng/ml （OR=23.916，95% CI：15.108-37.860，P<0.001），纤维蛋白（原）降解产物>13.81μg/ml （OR=3.873，95% CI：2.614-5.739，P<0.001）及年龄是脊柱骨折术前发生DVT的独立危险因素，且36~50岁、51~65岁、65岁以上分别是18~35岁患者发生DVT的2.49、2.59、4.02倍。
结论：脊柱骨折术前DVT的发生率13.10%（137/1 046）；术前合并骨质疏松症、低蛋白血症、低密度脂蛋白>4.645 mmol/L、血浆D-二聚体>558.00 ng/ml、纤维蛋白（原）降解产物>13.81μg/ml及年龄是发生DVT的危险因素，且年龄越大，发生DVT的风险越高。 |
| 【关键词】脊柱骨折 术前深静脉血栓 发生率 危险因素 |
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| Prevalence and risk factors of preoperative deep venous thromboembolism in spinal fracture |
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ABSTRACT
Objective: To investigate the incidence of lower extremity deep vein thrombosis (DVT) before surgery in patients with spinal fracture and analyze its risk factors.
Methods: The clinical data of 1 046 patients with spinal fracture who underwent surgery from October 2017 to December 2020 were retrospectively analyzed, including patient's age, gender, body mass index (BMI), smoking history, complications, the time from injury to diagnosis of DVT, blood index results on admission. The complications included hypertension, osteoporosis, diabetes, coronary heart disease, chronic obstructive pulmonary disease (COPD), anemia, obesity, hypokalemia, hyponatremia, hypoproteinemia, renal insufficiency, spinal cord injury;blood index results on admission included hematocrit (HCT), creatinine (Cre), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein(LDL), D-dimer(D-D), fibrin/fibrinogen degradation products(FDP), and C-reactive protein(CRP). The patients were divided into group according to whether DVT was diagnosed by the lower extremity venous ultrasonography after admission to pre-operation. The patients with DVT were set as the DVT group, and the patients without DVT were set as the non-DVT group. First, the above-mentioned possible risk factors were analyzed by univariate analysis, and then the risk factors of DVT before spinal fracture surgery were analyzed by multivariate Logistic regression.
Results: Among 1 046 patients with spinal fracture, 137 had DVT before operation and 909 had no DVT. There were significant differences in age, the incidence of preoperative osteoporosis, diabetes, anemia, hypoalbuminemia, the levels of LDL, plasma D-D, FDP, and CRP between the two groups (P<0.05). Multivariate Logistic regression analysis showed that osteoporosis (OR=3.116, 95%CI:1.816-5.346, P<0.001), hypoproteinemia (OR=2.508, 95%CI:1.583-3.974, P<0.001), preoperative serum LDL>4.645 mmol/L(OR=2.586, 95%CI:1.394-4.798, P<0.001), plasma D-D>558.00 ng/ml (OR=23.916, 95%CI:15.108-37.860, P<0.001), FDP>13.81μg/ml(OR=3.873, 95%CI:2.614-5.739, P<0.001) and age were independent risk factors for the occurrence of DVT before spinal fracture surgery, and the incidence of DVT in patients aged 36-50, 51-65 and over 65 years was 2.49, 2.59 and 4.02 times of those aged 18-35 years, respectively.
Conclusion: The incidence of preoperative DVT in patients with spinal fracture is 13.10%(137/1 046). Preoperative complicating osteoporosis, hypoalbuminemia, serum LDL>4.645 mmol/L, plasma D-D> 558.00 ng/ml, FDP> 13.81μg/ml and age are risk factors for DVT. And the older the patient, the higher the risk of DVT. |
| KEY WORDS Spinal fractures Preoperative deep venous thromboembolism Prevalence Risk factors |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 傲然·马合沙提,杨毅,哈力·哈布力汗,金格勒.脊柱骨折术前下肢深静脉血栓发生率及其危险因素分析[J].中国骨伤,2022,35(8):717~723 |
| 英文格式: | Aoran·Maheshati,YANG Yi,Hali·Habulihan,Jingele.Prevalence and risk factors of preoperative deep venous thromboembolism in spinal fracture[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(8):717~723 |
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