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[1]王海瑩,張子朋,呂冰.高能量胸腰椎骨折圍手術期下肢深靜脈血栓形成的危險因素分析[J].中醫(yī)正骨,2022,34(02):24-30.
　WANG Haiying,ZHANG Zipeng,LYU Bing.Analysis of risk factors for lower limb deep venous thrombosis in the perioperative period of high-energy thoracolumbar fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(02):24-30.
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高能量胸腰椎骨折圍手術期下肢深靜脈血栓形成的危險因素分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數:
2022年02期
頁碼:
24-30
欄目:
臨床研究
出版日期:
2022-02-20

文章信息/Info

Title:
Analysis of risk factors for lower limb deep venous thrombosis in the perioperative period of high-energy thoracolumbar fractures
作者:
王海瑩; 張子朋; 呂冰
保定市第一中心醫(yī)院,河北 保定 071000
Author(s):
WANG Haiying; ZHANG Zipeng; LYU Bing
Baoding No.1 Central Hospital,Baoding 071000,Hebei,China
關鍵詞:
脊柱骨折;  胸椎;  腰椎;  靜脈血栓形成;  危險因素;  Logistic模型
Keywords:
spinal fractures;  thoracic vertebrae;  lumbar vertebrae;  venous thrombosis;  risk factors;  Logistic models
摘要:
目的:探討高能量胸腰椎骨折圍手術期下肢深靜脈血栓形成(deep venous thrombosis,DVT)的危險因素。方法:選擇429例采用手術治療的高能量胸腰椎骨折患者,從病歷系統(tǒng)中提取年齡、性別、體質量指數、是否合并高血壓、是否合并糖尿病、是否合并冠心病、術前和術后美國脊柱損傷協(xié)會(American Spinal Injury Association,ASIA)脊髓損傷神經功能分級、骨折至手術時間、臥床時間、D-二聚體血漿含量、纖維蛋白原血漿含量、凝血酶時間(thrombin time,TT)、活化部分促凝血酶原激酶時間(activated partial thromboplastin time,APTT)、凝血酶原時間(prothrombin time,PT)、高密度脂蛋白(high density lipoprotein,HDL)血清含量、低密度脂蛋白(low density lipoprotein,LDL)血清含量、血小板計數、紅細胞體積分布寬度(red cell volume distribution width,RDW)變異系數、手術時間、出血量、補液量、是否輸血、引流量等信息。按照術前是否發(fā)生下肢DVT將患者分為術前下肢DVT組和術前無下肢DVT組,按照術后是否發(fā)生下肢DVT將患者分為術后下肢DVT組和術后無下肢DVT組。分別對術前下肢DVT組和術前無下肢DVT組、術后下肢DVT組和術后無下肢DVT組患者的相關信息進行單因素分析,然后對其中組間差異有統(tǒng)計學意義的因素分別進行多因素Logistic回歸分析。結果:術前下肢DVT組62例,術前無下肢DVT組367例。2組患者的年齡、術前ASIA脊髓損傷神經功能分級、骨折至手術時間、D-二聚體血漿含量、RDW變異系數比較,組間差異均有統(tǒng)計學意義(t=2.960,P=0.004; χ2=12.161,P=0.007; t=9.040,P=0.000; Z=-6.771,P=0.000; Z=-7.030,P=0.000); 2組患者的性別、體質量指數、是否合并高血壓、是否合并糖尿病、是否合并冠心病、纖維蛋白原血漿含量、TT、APTT、PT、HDL血清含量、LDL血清含量、血小板計數比較,組間差異均無統(tǒng)計學意義(χ2=0.104,P=0.747; t=0.734,P=0.460; χ2=0.042,P=0.838; χ2=0.762,P=0.383; χ2=0.449,P=0.503; Z=-0.640,P=0.522; Z=-1.250,P=0.211; Z=-0.203,P=0.839; Z=-1.691,P=0.091; Z=-1.146,P=0.252; Z=-0.839,P=0.401; Z=-1.589,P=0.112)。Logistic回歸分析結果顯示,骨折至手術時間、術前ASIA脊髓損傷神經功能分級(A級)、D-二聚體血漿含量是高能量胸腰椎骨折術前發(fā)生下肢DVT的危險因素(β=0.137,P=0.001,OR=1.147; β=2.117,P=0.000,OR=8.308; β=0.187,P=0.000,OR=1.205)。術后下肢DVT組83例,術后無下肢DVT組346例。2組患者的年齡、術后ASIA脊髓損傷神經功能分級、臥床時間、D-二聚體血漿含量、纖維蛋白原血漿含量、手術時間、出血量、補液量、是否輸血、引流量比較,組間差異均有統(tǒng)計學意義(t=4.780,P=0.000; χ2=15.902,P=0.001; Z=-4.422,P=0.000; Z=-7.078,P=0.000; Z=-8.486,P=0.000; Z=-4.692,P=0.000; Z=-4.346,P=0.000; Z=-2.628,P=0.009; χ2=10.298,P=0.005; Z=-2.777,P=0.005); 2組患者的性別、體質量指數、是否合并高血壓、是否合并糖尿病、是否合并冠心病、TT、APTT、PT比較,組間差異均無統(tǒng)計學意義(χ2=0.892,P=0.345; t=1.550,P=0.122; χ2=1.212,P=0.271; χ2=0.004,P=0.948; χ2=0.049,P=0.825; Z=-0.870,P=0.384; Z=-0.637,P=0.524; Z=-0.228,P=0.819)。Logistic回歸分析結果顯示,年齡、術后ASIA脊髓損傷神經功能分級(A級)、臥床時間、D-二聚體血漿含量、纖維蛋白原血漿含量、輸血是高能量胸腰椎骨折術后發(fā)生下肢DVT的危險因素(β=0.041,P=0.006,OR=1.042; β=2.239,P=0.000,OR=10.374; β=0.159,P=0.008,OR=1.172; β=0.591,P=0.000,OR=1.805; β=0.428,P=0.000,OR=1.535; β=0.708,P=0.036,OR=2.030)。結論:骨折至手術時間、術前ASIA脊髓損傷神經功能分級(A級)、D-二聚體血漿含量是高能量胸腰椎骨折術前發(fā)生下肢DVT的危險因素; 年齡、術后ASIA脊髓損傷神經功能分級(A級)、臥床時間、D-二聚體血漿含量、纖維蛋白原血漿含量、輸血是術后發(fā)生下肢DVT的危險因素。
Abstract:
Objective:To explore the risk factors for lower limb deep venous thrombosis(LDVT)in the perioperative period of high-energy thoracolumbar fractures.Methods:Four hundred and twenty-nine patients who underwent surgery for treatment of high-energy thoracolumbar fractures were selected,and the information including age,gender,body mass index(BMI),whether combined with hypertension,whether combined with diabetes,whether combined with coronary heart disease(CHD),preoperative and postoperative American Spinal Injury Association(ASIA)neurological classification of spinal cord injury,duration from fracture to surgery,bed rest time,plasma D-dimer level,plasma fibrinogen level,thrombin time(TT),activated partial thromboplastin time(APTT),prothrombin time(PT),serum high density lipoprotein(HDL)level,serum low density lipoprotein(LDL)level,platelet count,coefficient of variation of red cell volume distribution width(RDW-CV),operative time,blood loss,volume of intravenous fluid infusion,blood transfusion or not and drainage volume was extracted from the Electronic Medical Record System(EMRS).The patients were divided into preoperative LDVT group(62 cases)and preoperative non-LDVT group(367 cases)according to whether LDVT was found before the surgery,and the patients were divided into postoperative LDVT group(83 cases)and postoperative non-LDVT group(346 cases)according to whether LDVT was found after the surgery.Single-factor analysis was performed on the information of patients in preoperative LDVT group and preoperative non-LDVT group,and those in postoperative LDVT group and postoperative non-LDVT group respectively,followed by multi-factor logistic regression analysis on the factors with significant differences between groups.Results:The differences were statistically significant between preoperative LDVT group and preoperative non-LDVT group in age,preoperative ASIA neurological classification of spinal cord injury,duration from fracture to surgery,plasma D-dimer level and RDW-CV(t=2.960,P=0.004; χ2=12.161,P=0.007; t=9.040,P=0.000; Z=-6.771,P=0.000; Z=-7.030,P=0.000).There was no statistical difference in gender,BMI,whether combined with hypertension,whether combined with diabetes,whether combined with CHD,plasma fibrinogen level,TT,APTT,PT,serum level of HDL,serum level of LDL and platelet count between preoperative LDVT group and preoperative non-LDVT group(χ2=0.104,P=0.747; t=0.734,P=0.460; χ2=0.042,P=0.838; χ2=0.762,P=0.383; χ2=0.449,P=0.503; Z=-0.640,P=0.522; Z=-1.250,P=0.211; Z=-0.203,P=0.839; Z=-1.691,P=0.091; Z=-1.146,P=0.252; Z=-0.839,P=0.401; Z=-1.589,P=0.112).The results of logistic regression analysis revealed that the duration from fracture to surgery,preoperative ASIA neurological classification of spinal cord injury(Grade A)and plasma D-dimer level were the risk factors for LDVT in patients with high-energy thoracolumbar fractures before the surgery(β=0.137,P=0.001,OR=1.147; β=2.117,P=0.000,OR=8.308; β=0.187,P=0.000,OR=1.205).The differences were statistically significant between postoperative LDVT group and postoperative non-LDVT group in age,postoperative ASIA neurological classification of spinal cord injury,bed rest time,plasma D-dimer level,plasma fibrinogen level,operative time,blood loss,volume of intravenous fluid infusion,blood transfusion or not and drainage volume(t=4.780,P=0.000; χ2=15.902,P=0.001; Z=-4.422,P=0.000; Z=-7.078,P=0.000; Z=-8.486,P=0.000; Z=-4.692,P=0.000; Z=-4.346,P=0.000; Z=-2.628,P=0.009; χ2=10.298,P=0.005; Z=-2.777,P=0.005).There was no statistical difference in gender,BMI,whether combined with hypertension,whether combined with diabetes,whether combined with CHD,TT,APTT and PT between postoperative LDVT group and postoperative non-LDVT group(χ2=0.892,P=0.345; t=1.550,P=0.122; χ2=1.212,P=0.271; χ2=0.004,P=0.948; χ2=0.049,P=0.825; Z=-0.870,P=0.384; Z=-0.637,P=0.524; Z=-0.228,P=0.819).The results of logistic regression analysis revealed that the age,postoperative ASIA neurological classification of spinal cord injury(Grade A),bed rest time,plasma D-dimer level,plasma fibrinogen level and blood transfusion were the risk factors for LDVT in patients with high-energy thoracolumbar fractures after the surgery(β=0.041,P=0.006,OR=1.042; β=2.239,P=0.000,OR=10.374; β=0.159,P=0.008,OR=1.172; β=0.591,P=0.000,OR=1.805; β=0.428,P=0.000,OR=1.535; β=0.708,P=0.036,OR=2.030).Conclusion:For patients with high-energy thoracolumbar fractures,the duration from fracture to surgery,preoperative ASIA neurological classification of spinal cord injury(Grade A)and plasma D-dimer level are the risk factors for LDVT before the surgery; while the age,postoperative ASIA neurological classification of spinal cord injury(Grade A),bed rest time,plasma D-dimer level,plasma fibrinogen level and blood transfusion are the risk factors for LDVT after the surgery.

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備注/Memo

備注/Memo:
基金項目:保定市科技計劃項目(2041ZF100)
通訊作者:呂冰 E-mail:[email protected]
更新日期/Last Update: 2022-02-20