CAJ | 학술논문

目的探讨髋臼、骨盆骨折患者术前发生深静脉血栓形成(DVT)的危险因素. 方法 2005年1月至2009年2月共收治448例髋臼或骨盆骨折患者,男347例,女101例；平均年龄为39 4岁(14～80岁).其中骨盆骨折122例,髋臼骨折326例.受伤至手术时间为0～315 d,平均13.4d.将患者年龄、性别、合并伤、合并系统性疾病、骨折类型(陈旧性骨折与否)、术前牵引制动、术前是否采取预防血栓的措施、D-二聚体水平及吸烟史作为自变量,术前是否发生DVT作为因变量(分为血栓组和非血栓组).利用x2检验确定影响DVT的危险因素,然后采用多因素Logistic回归分析确定影响DVT的独立危险因素及相应比值比(OR)、95％的可信区间(CI). 结果共有79例(17 6％)患者发生下肢DVT.年龄≥45岁、合并系统性疾病、未采取预防血栓措施、血清D-二聚体＞500μg/L与血栓的发生有关(P＜0.05).多因素Logistic回归分析结果显示:年龄≥45岁[OR=2 114,95％ CI(1.254,3 564),P=0.005]、合并系统性疾病[OR =2.302,95％ CI(1.270,4.175),P =0.006]、未采取血栓预防措施[OR=2.270,95％ CI(1.322,3.897),P=0.003]是影响DVT发生的独立危险因素.结论年龄≥45岁、合并系统性疾病及未采取血栓预防措施的患者发生DVT的可能性较大.髋臼、骨盆骨折患者术前必须采取预防措施,并严密监测血栓是否形成.
목적 탐토관구、골분골절환자술전발생심정맥혈전형성(DVT)적위험인소. 방법 2005년1월지2009년2월공수치448례관구혹골분골절환자,남347례,녀101례；평균년령위39 4세(14～80세).기중골분골절122례,관구골절326례.수상지수술시간위0～315 d,평균13.4d.장환자년령、성별、합병상、합병계통성질병、골절류형(진구성골절여부)、술전견인제동、술전시부채취예방혈전적조시、D-이취체수평급흡연사작위자변량,술전시부발생DVT작위인변량(분위혈전조화비혈전조).이용x2검험학정영향DVT적위험인소,연후채용다인소Logistic회귀분석학정영향DVT적독립위험인소급상응비치비(OR)、95％적가신구간(CI). 결과 공유79례(17 6％)환자발생하지DVT.년령≥45세、합병계통성질병、미채취예방혈전조시、혈청D-이취체＞500μg/L여혈전적발생유관(P＜0.05).다인소Logistic회귀분석결과현시:년령≥45세[OR=2 114,95％ CI(1.254,3 564),P=0.005]、합병계통성질병[OR =2.302,95％ CI(1.270,4.175),P =0.006]、미채취혈전예방조시[OR=2.270,95％ CI(1.322,3.897),P=0.003]시영향DVT발생적독립위험인소.결론 년령≥45세、합병계통성질병급미채취혈전예방조시적환자발생DVT적가능성교대.관구、골분골절환자술전필수채취예방조시,병엄밀감측혈전시부형성.
Objective To analyze the preoperative risk factors for deep venous thromboembolism (DVT) in patients with acetabular and pelvic fractures. Methods The clinical data were collected of 448 inpatients who had been treated in our department for acetabular and/or pelvic fractures from January 2005 to February 2009.There were 122 pelvic and 326 acetabular fractures,347 male and 101 female patients.Their average age was 39.4 years (from 14 to 80 years).Age,sex,associated injury,associated systemic disease,fracture type, preoperative traction and immobilization, preoperative prophylactic measures against DVT,D-Dimer level,and smoking history of the patients were taken as independent variables and occurrence of preoperative DVT as the dependent variable (DVT group and DVT-free group).The Chi-square test and Multi-factor Logistic regression were conducted to determine the risk factors,independent risk factors (corresponding odds ratios and confidence intervals of 95％ ) associated with DVT. Results DVT occurred at the lower limb in 79 patients(17.6％ ).Age older than 45 years,associated systemic disease,absence of prophylaxis and D-Dimer level greater than 500 μg/L were found to be the risk factors sssoeiated with DVT (P ＜0.05).The independent risk factors associated with DVT were age older than 45 years[OR=2.114,95％ CI(1.254,3.564),P =0.005],associated systemic disease [OR =2.302,95％ CI (1.270,4.175),P=0.006],and absence of prophylaxis[OR =2.270,95％ CI( 1.322,3.897),P =0.003]. Conclusions Among paticnts with acetabular and pelvic fractures,preoperative DVT is highly probable in those who are older than 45 years old,have a systemic disease,and take no prophylaxis against DVT.Consequently,preoperative DVT should be closely monitored and prophylactic measures sbould be taken.