摘要目的 探讨足踝部损伤患者术前并发下肢深静脉血栓形成（DVT）的相关危险因素。方法 回顾性研究。纳入2015年1月—2021年1月南通大学附属医院收治的881例足踝部损伤患者,根据术前血管超声检查,并发DVT患者34例,无DVT患者847例。从847例无DVT患者中按数字表法随机抽取35例为非血栓组,其中男16例、女19例,年龄22~70岁。并发DVT 34例为血栓组,其中男16例、女18例,年龄35~80岁。患者均行足踝部切开复位钢板或克氏针内固定术或跟腱缝合术。统计881例足踝部损伤患者术前并发下肢DVT的发生率、发生部位及出现时间;对血栓组和非血栓组患者,纳入性别、年龄、体质量指数（BMI）、是否有合并伤、制动时间、制动方式、高血压、糖尿病、高血脂等影响因素,做术前并发DVT的单因素、多因素logistic回归分析,采用比值比（OR）及95%可信区间（CI）进行风险评估。结果 881例患者中,34例并发DVT,发生率为3.86%;其中,DVT发生时间≤7 d 19例,8~14 d 9例,>14 d 6例;血栓发生于胫前静脉2例,腓浅静脉血栓7例,肌间静脉血栓25例。34例患者经治疗后均痊愈,无一例死亡。血栓组与非血栓组比较,在年龄、BMI、存在合并伤、制动时间、合并高血压及糖尿病等方面差异均有统计学意义（P值均<0.05）。多因素logistic回归分析显示：存在合并伤（OR=2.790,95% CI 1.315~5.918,P=0.007）、制动时间（OR=2.387,95% CI 1.112~5.122,P=0.026）是足踝部损伤患者术前并发DVT的独立危险因素。结论 有合并伤、制动时间≥5 d是足踝部损伤患者术前并发DVT的独立危险因素。对于足踝部损伤患者,术前应加强下肢静脉血栓形成预防措施,减少并发DVT的风险。
Abstract：Objective To investigate the preoperative risk factors for deep vein thrombosis (DVT) of lower extremity in patients with foot and ankle injuries. Methods A retrospective cross-sectional study of 881 patients with foot and ankle injuries in the Affiliated Hospital of Nantong University from January 2015 to January 2021 was conducted. Vascular ultrasound examination revealed 34 patients with DVT of lower extremity and 847 patients without DVT of lower extremity at preoperative. Among the 847 patients, 35 patients (16 males and 19 females aged 22–70 years) without thrombosis were randomly selected as the non-thrombotic group . The 34 patients with DVT (16 males and 18 females aged 35–80 years) were set as the thrombotic group. All patients underwent open reduction plate, Kirschner wire internal fixation, or Achilles tendon suture. The incidence, location, and occurrence time of DVT in the 881 patients with foot and ankle injuries before operation were analyzed. Univariate and multivariate logistic regression analyses of preoperative DVT were performed in the thrombotic and non-thrombotic groups. Factors such as gender, age, body mass index (BMI), complication of injury, braking time, braking method, hypertension, diabetes, and hyperlipidemia were considered. Risk factors for DVT were assessed by odds ratios (OR) and 95% confidence intervals (CI). Results DVT at the lower extremity occurred in 34 (3.86%) of 881 patients. The occurrence time of DVT in these patients was ≤7 days in 19 cases, 8-14 days in 9 cases, and ≥14 days in 6 cases. Thrombosis occurred in the anterior tibial vein in 2 cases, the superficial peroneal vein in 7 cases, and the intermuscular vein in 25 cases. All 34 patients recovered after treatment. Significant differences in age, BMI, associated injury, braking time, hypertension, and diabetes were found between the thrombotic and non-thrombotic groups (all P values <0.05). Logistic regression analysis showed that associated injury (OR = 2.790, 95% CI 1.315–5.918, P = 0.007) and braking time (OR =2.387, 95% CI 1.112–5.122, P = 0.026) were independent risk factors for DVT in patients with foot and ankle injuries before operation. Conclusion Associated injury and prolonged braking time ≥5 days are independent risk factors of DVT in patients with foot and ankle injuries before operation. For patients with foot and ankle injuries, preoperative thrombosis prevention measures should be strengthened to reduce the risk of concurrent DVT.
杨帅杰, 周振宇, 马洪冬. 足踝部损伤术前并发下肢深静脉血栓形成的危险因素分析[J]. 中华解剖与临床杂志, 2022, 27(4): 247-250.
Yang Shuaijie, Zhou Zhenyu, Ma Hongdong. Preoperative risk factors for deep vein thrombosis of lower extremity in patients with foot and ankle injury. Chinese Journal of Anatomy and Clinics, 2022, 27(4): 247-250.
Levitan B, Yuan Z, Turpie AG, et al.Benefit-risk assessment of rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total hip or knee arthroplasty[J]. Vasc Health Risk Manag, 2014,10:157-167. DOI: 10.2147/VHRM.S54714.
[2]
Tang Y, Wang K, Shi Z, et al.A RCT study of rivaroxaban, low-molecular-weight heparin, and sequential medication regimens for the prevention of venous thrombosis after internal fixation of hip fracture[J]. Biomed Pharmacother, 2017,92:982-988. DOI: 10.1016/j.biopha.2017.05.107.
[3]
Fuji T, Akagi M, Abe Y, et al.Incidence of venous thromboembolism and bleeding events in patients with lower extremity orthopedic surgery: a retrospective analysis of a Japanese healthcare database[J]. J Orthop Surg Res, 2017, 12(1):55. DOI: 10.1186/s13018-017-0549-4.
[4]
张慧霞, 束浩明, 陈宝定, 等. 下肢骨折部位与深静脉血栓发生的关系[J]. 江苏医药, 2017, 43(12): 863-865. DOI: 10.19460/j.cnki.0253-3685.2017.12.011.Zhang HX, Shu HM, Chen BD, et al.Relationship of location of lower limb fractures and occurrence of deep veinthrombosis in lower extremities[J]. Jiangsu Med J, 2017, 43(12): 863-865. DOI: 10.19460/j.cnki.0253-3685.2017.12.011.
[5]
凌坤,庞龙,陈志荣,等.下肢骨折并发静脉血栓性疾病男女性发病差异临床分析[J]. 中国骨与关节损伤杂志, 2013, 28(10): 941-943. DOI: 10.7531/j.issn.1672-9935.2013.10.014.Ling K, Pang L, Chen ZR, et al.Clinical analysis of patients with lower limb fractures accomplished with venous thromboemlolism[J]. Chin J Bone Joint Injury, 2013, 28(10): 941-943. DOI: 10.7531/j.issn.1672-9935.2013.10.014.
[6]
Ahmad J, Lynch MK, Maltenfort M.Incidence and risk factors of venous thromboembolism after orthopaedic foot and ankle surgery[J]. Foot Ankle Spec, 2017, 10(5): 449-454. DOI: 10.1177/1938640017704944.
[7]
Riou B, Rothmann C, Lecoules N, et al.Incidence and risk factors for venous thromboembolism in patients with nonsurgical isolated lower limb injuries[J]. Am J Emerg Med, 2007, 25(5): 502-508. DOI: 10.1016/j.ajem.2006.09.012.
[8]
Heijboer R, Lubberts B, Guss D, et al.Venous thromboembolism and bleeding adverse events in lower leg, ankle, and foot orthopaedic surgery with and without anticoagulants[J]. J Bone Joint Surg Am, 2019, 101(6): 539-546. DOI: 10.2106/JBJS.18.00346.
[9]
Carr P, Ehredt DJ, Dawoodian A.Prevention of deep venous thromboembolism in foot and ankle surgery[J]. Clin Podiatr Med Surg, 2019,36(1):21-35. DOI: 10.1016/j.cpm.2018.08.002.
[10]
Heijboer R, Lubberts B, Guss D, et al.Incidence and risk factors associated with venous thromboembolism after orthopaedic below-knee surgery[J]. J Am Acad Orthop Surg, 2019, 27(10):e482-e490. DOI: 10.5435/JAAOS-D-17-00787.
[11]
Richey JM, Ritterman Weintraub ML, Schuberth JM.Incidence and risk factors of symptomatic venous thromboembolism following foot and ankle surgery[J]. Foot Ankle Int, 2019, 40(1):98-104. DOI: 10.1177/1071100718794851.
[12]
Lassen MR, Gallus A, Raskob GE, et al.Apixaban versus enoxaparin for thromboprophylaxis after hip replacement[J]. N Engl J Med, 2010, 363(26): 2487-2498. DOI: 10.1056/NEJMoa1006885.
[13]
Lapidus L, Börretzen J, Fahlén M, et al.Home treatment of deep vein thrombosis. an out-patient treatment model with once-daily injection of low-molecular-weight heparin (tinzaparin) in 555 patients[J]. Pathophysiol Haemost Thromb, 2002, 32(2):59-66. DOI: 10.1159/000065077.
[14]
Geerts WH, Code KI, Jay RM, et al.A prospective study of venous thromboembolism after major trauma[J]. N Engl J Med, 1994,331(24):1601-1606. DOI: 10.1056/NEJM199412153312401.
[15]
Hjelmstedt A, Bergvall U.Incidence of thrombosis in patients with tibial fractures[J]. Acta Chir Scand, 1968,134(3):209-218.
[16]
Wukich DK, Waters DH.Thromboembolism following foot and ankle surgery: a case series and literature review[J]. J Foot Ankle Surg, 2008, 47(3): 243-249. DOI: 10.1053/j.jfas.2008.02.003.
[17]
Basques BA, Miller CP, Golinvaux NS, et al.Risk factors for thromboembolic events after surgery for ankle fractures[J]. Am J Orthop (Belle Mead NJ), 2015,44(7):E220-E224.
[18]
姚杰, 孟尽海, 王文娟, 等. 骨科手术病人术后下肢深静脉血栓形成的危险因素[J]. 中华麻醉学杂志, 2013, 33(4):413-416. DOI: 10.3760/cma.j.issn.0254-1416.2013.04.005.Yao J, Meng JH, Wang WJ, et al.Risk factors for deep vein thrombosis in lower extremity after orthopedic surgery[J]. Chin J Anesthesiol, 2013, 33(4): 413-416. DOI: 10.3760/cma.j.issn.0254-1416.2013.04.005.
2022, Vol. 27 
