Incidence and risk factors of deep venous thrombosis in lower extremity in patients with tibial plateau fracture / 中华创伤骨科杂志

ABSTRACT

Objective To investigate the incidence and risk factors of deep venous thrombosis (DVT) in lower extremity in patients with tibial plateau fracture.Methods The data from 148 patients with tibial plateau fracture were retrospectively analyzed who had been admitted to the Department of Orthopaedic Trauma,Honghui Hospital between September 2014 and December 2017.They were 90 males and 58 females,aged from 19 to 83 years (average,47.2 ± 13.1 years).According to the Schatzker classification of tibial plateau fractures,24 cases belonged to type Ⅰ,17 to type Ⅱ,25 to type Ⅲ,29 to type Ⅳ,34 to type Ⅴ,and 19 to type Ⅵ.The incidence of DVT was detected by venous ultrasound of bilateral lower extremities before and after surgery.The factors related to the occurrence of DVT were statistically analyzed.Univariate analysis was used to determine risk factors,and multivariate logistic regression analysis was used to identify the primary independent risk factors.Results The preoperative DVT incidence was 43.92％ (65/148) and the postoperative DVT incidence 52.70％ (78/148).Distal thrombus predominated both preoperatively and postoperatively.Age (OR =1.043,95％ CI 1.015 ～ 1.072,P =0.002) and D-dimer level upon admission (OR =1.219,95％ CI 1.009 ～ 1.473,P =0.040) were independent risk factors for preoperative DVT formation;age (OR =1.075,95％ CI 1.042 ～ 1.110,P =0.000),operative time (OR =0.994,95％ CI 0.989～0.999,P=0.016),D-dimer level at 1 day postoperatively (OR=1.135,95％ CI 1.025～1.258,P =0.015) and at 3 days postoperatively (OR =1.366,95％ CI 1.008 ～ 1.853,P =0.044) were independent risk factors for postoperative DVT.Conclusions The incidence of DVT in the lower extremity may be high in patients with tibial plateau fracture.Distal thrombus is the main manifestation.In fracture patients,especially the middle-aged and elderly ones,dynamic monitoring of D-dimer level should be combined with lower extremity venous ultrasound for early diagnosis of DVT.In patients with lower extremity DVT,surgical progress should be accelerated on the basis of good surgical quality to reduce the incidence of postoperative lower extremity DVT.