Clinical Study On The Susceptible Factors Of Venous Thromboembolism In Pelvic And Lower Limb Extremity Fracture Patients

Objective:To explore the risk factors of venous thromboembolism(VTE)among patients with pelvic fracture and lower limb extremity fractures and the occurence of venous thromboembolism during hospitalization.Methods: 619 patients with pelvic and lower extremity fractures were admitted to the study,from department of orthopedics,the First Affiliated Hospital of Da Lian medical university from January 2017 to January 2018.Patient-related data were reviewed through our hospital’s disease system.Data included age,gender,ASA classification,venous thrombosis,fracture type,preoperative time,heart failure,myocardial infarction,pneumonia,cerebral thrombosis,BMI index,transfer status,coagulation D-dimer,PT(prothrombin time),APTT(activated part thromboplastin time),TT(thrombin time),FIB and blood type.Make a correlation between Venous thromboembolism(VTE)and age,gender,classification of ASA,preoperative time,heart failure,myocardial infarction,pneumonia,cerebral thrombosis,BMI index,transfer status,coagulation D-dimer,FIB,PT,APTT,TT,blood type.The data of patients undergoing interfacility transfer(TR)and patients admitted directly(DA)were compared.Results :619 patients met the inclusion criteria,and comprised 298 males and 321 females.Mean age was 60 years old(range from 21 to 94).It comprised 14 pelvic fractures,8 acetabular fractures,129 femoral neck fractures,160 intertrochanteric fractures,10 subtrochanteric fractures,35 femoral shaft fractures,9 distal femoral fractures,27 patellar fractures,48 tibial plateau fractures,43 tibiofibular fractures,28 Pilon fractures,78 ankle fractures and 30 foot fractures;Mean TTS(time to surgery)was 5.3 days,and mean time of hospitalization was 10.9 days.According to anesthesia ASA classification: 50 people in Class I,313 people in Class II,218 people in Class III and 38 people in Class IV.19 patients with VTE;36 patients with pneumonia,25 patients with cerebral infarction,21 patients with heart failure,and 20 patients with cancer;64 patients who were transferred from the external hospital to our hospital(Interfacility Transfer,TR),direct admission(DA)555 patients;98 patients with traffic accidents,462 patients with falls,25 patients with fall injuries,15 with bruises,19 with sprains;It consisted 201 patients with type O blood,177 patients with type A blood,173 patients with type B blood and 68 patients with type AB blood.;The results of multivariate logistic regression analysis of VTE showed that age(OR=1.04,CI1.02 ~ 1.48,P<0.05),preoperative time(OR=1.146,CI1.05 ~ 1.23,P<0.05).D-dimer(OR=1.46,CI1.01 ~ 2.65,P<0.05),transfer patients(OR=8.53,CI2.48 ~29.26,P<0.05)were associated with venous thrombosis in this study.2.The incidence of venous thrombosis in the TR group was significantly higher compared with the DA group(13% vs.1.1%,respectively).The average age is greater in DA group compared with TR group : 61 ± 19 years versus 55 ± 16.7years,respectively(P<0.05).The average preoperative time is greater in TR group compared with DA group : 10.0±4.1 days versus 5.3±3.6 days,respectively(P<0.05).Conclusion: Vein thrombosis of pelvic or lower limb fractures was related to age,preoperative time,D-dimer,and transfer.The older the patient is,the longer the preoperative time,the higher D-dimer,the more likely the patient has venous thrombosis.The possibility of patients undergoing interfacility transfer suffering from venous thrombosis is higher than patients directly admitted to hospital.