Retrospective Study On Deep Venous Thrombosis Of Lower Extremity In Patients With Hip Fracture

Part Ⅰ:Incidence and related characteristics of the lower extremity deep vein thrombosis in patients undergoing hip fracture surgeryObjective:To determine the perioperative incidence of deep venous thrombosis(DVT)in patients with hip fracture the distribution of DVT in each lower extremity deep vein,and the patient characteristics of DVT formation.Methods:A total of 795 patients who underwent hip fracture surgery were included in this retrospective case study.The general information,perioperative related venous blood test results,and lower extremity deep vein Doppler ultrasonography were recorded.Results:Atotal of 795 patients with hip fractures were included in this study.The incidence of DVT during the whole perioperative period was 17.11%(136/795).Among all the studies on the distribution of lower extremity deep vein thrombosis,the incidence of gastrocnemius muscle venous thrombosis is the highest Among them,the incidence of gastrocnemius muscle venous thrombosis in patients with intertrochanteric fracture is 55%,and the incidence of other high-risk veins popliteal vein,posterior tibial vein,peroneal vein,femoral vein and iliac vein)thrombosis is 45%.The incidence of gastrocnemius muscular vein thrombosis in patients with femoral neck fiacture was 52%,and the incidence of other highrisk veins(popliteal vein,posterior tibial vein peroneal vein,femoral vein and iliac vein)thrombosis was 48%.Age-adjusted Charlson comorbidity index,age and previous history of coronary heart disease were closely related to lower extremity deep vein thrombosis in patients with hip fracture.At the same time,we observed the difference of coagulation function in the diagnosis of lower extremity deep vein thrombosis.Due to the influence of fracture trauma,D-dimer is significantly higher than the normal reference interval.D-dimer>8.21(3.48,15.46)mg/L in patients with femoral intertrochanteric frature can predict the formation of lower extremity venous thrombosis.In the study of liver and kidney function and blood routine after injury of hip fracture,it was found that patients with femoral intertrochanteric fracture had more bleeding after trauma,and were more likely to have hypovolemic shock and acute kidney injury.At the same time,low albumin,low hemoglobin and renal function injury in patients with femoral neck fracture promoted the fomation of lower extremity deep vein thrombosis.In the study on the relationship between postoperative clinical outcomes and DVT in patients with hip fracture,we found that patients with femoral intertrochanteric fracture were more likely to have acute kidney injury after surgical treatment compared with non-thrombosis group,and the patients with femoral neck fracture were more likely to have anamia compared with non-thrombosis group.Conclusion:There is a high incidence of DVT formation in patients with hip fracture.Patients with intertrochanteric fracture are more likely to develop DVT,and the occurrence of DVT is correlated with patient age,past medical history and relevant laboratory indicators.At the same time,there are different postoperative outcomes between DVT group and non-DVT group in patients with intertrochanteric fracture and femoral neck fracture.Part Ⅱ:Risk factors of new onset deep venous thrombosis in hip fracture patients after surgeryObjective:TTo determine the incidence and distribution of DVT in patients with hip fracture after surgery,and to explore the risk factors that lead to new DVT in patients with hip fracture after surgery.Methods:This study was a retrospective case study,a total of 182 patients with hip fracture surgery were included The results of deep vein Doppler ultrasound examination of the lower extremities before and after surgery,the use of anticoagulant drugs before surgery,the timing of surgical intervention,and the anesthesia method used for surgery were recorded.Results:A total of 182 patients with hip fracture were enrolled in this study.The incidence of postoperative DVT was 17.03%(31/182).The new incidence of deep vein thrombosis in patients with intetrochanteric fracture after PFNA was 34.88%(15/43).The new incidence oflower extremity deep vein thrombosis in patients with femoral neck fracture after total hip replacement was 11.51%(16/139).The distribution of lower extremity deep vein thrombosis in patients with hip fracture:the incidence of gastrocnemius muscle venous thrombosis was the highest,accounting for 52%(17 cases)oft he total.The incidence of other high-risk veins(popliteal vein,posterior tibial vein,peroneal vein femoral vein and iliac vein)thrombosis was 45%(14 cases).A total of 73 patients hip fracture were given anticoagulant drugs before operation(53 patients were given nadroparin calcium,18 patients were given enoxaparin sodium,and 2 patients were given rivaroxaban).In contrast to previous studies,patients who received preoperative anticoagulation had a higher incidence of postoperative venous thrombosis,both in the gastrocnemius thrombosis group(16.40%vs 4.60%)and the high-risk venous thrombosis group(11.00%vs 5.50%).The difference between the two groups was statistically significant(P<0.05).There was no statistical difference was found between the two different LMWH(enoxaparin sodium vs nadroparin calcium)(P>0.05).In addition,we explored that there was no significant relationship between the timing of surgical intervention and the incidence of postoperative DVT in patients with hip fracture.But,using different anesthesia methods,there were significant differences in postoperative thrombosis.The gastrocnemius muscle thrombosis in patients with hip fracture treated with combined anesthesia and general anesthesia is significantly higher than that in patients with spinal anesthesia.Patients with spinal anesthesia and general anesthesia are more likely to form high-risk lower extremity venous thrombosis than patients with general anesthesia.(P<0.05).Conclusion:The incidence of postoperative new DVT is still high in patients with hip fiacture.Anticoagulant drugs given before operation can’t seem to play a preventive role.The timing of surgical intervention has no significant relationship with the incidence of new-onset DVT after hip fracture surgery.When combined anesthesia and general anesthesia are used,the intermuscular thrombosis of gastrocnemius of lower limbs is significantly higher than that of patients with spinal anesthesia,while patients with spinal anesthesia and general anesthesia are more likely to form high-risk venous thrombosis of lower limbs compared with combined anesthesia.