The Prediction And Early Diagnosis For Lower Extremity Deep Vein Thrombosis (LDVT) Of Patients After Major Orthopedic Operations

ObjectiveTo study the possibility of using a new diagnostic method by correlated laboratory indexes combine with Wells rule predict and early diagnose LDVT of patients after major orthopedic operations, so as to afford a simply simple,convenient and accurate method for the prediction and early diagnosis, improve the cure rate of operation and cut down the rate of mortality rate.MethodsThere are 75 patients after major orthopedic operations of orthopedic department of The People's Hospital of Zhuhai, who had not received anticoagulant therapy from March lth 2009 to March lth 2011. Aged 42 to 92 years, mean 64.8±12.4 years. According to risk score table (Wells'rule)of LDVT, The patients were divide into three groups on the third day postoperative: low risk(<1 point), middle risk (1 to 2 points), high risk((?)3points). Then we draw vein blood for testing correlated laboratory indexes, includingAPTT, PT, FG, D-dimer and vWF:Ag. The result was recorded. When came to 4-7 days after the day operation, Color doppler flow imaging(CDFI) was performed with double-blind method in patients for diagnosing LDVT, also the result was recorded. To compare these laboratory indexes in wells groups, and make correlation analysis between laboratory indexes and wells scores, and compare difference of the laboratory indexes between LDVT group and no-LDVT one, then the indexes which associated with LDVT were selected and the correlation of theses indexes and LDVT were taken into account. At last, to take the result of Color doppler flow imaging for criterion and validated the effect by correlated laboratory indexes combined with Wells'score anticipate and early diagnosis LDVT of patients after major orthopedic operations.Results1. APTT,PT among the three groups were no significant difference (P>0.05), compared the differences between any two groups were no significant difference (P>0.05); the difference of FG,D-dimer,vWF:Ag in the three groups were significant difference (P<0.05), the midlle-risk group was higher than low-risk one and the high-risk group was higher than the midlle-group(P<0.05).2.The laboratory indexes which were comfirmed LDVT and no-LDVT by CDFI examination, the diference of APTT and PT were no significant difference (P>0.05), and FG,D-dimer,vWF:Ag were significant difference (P< 0.05),the three indexes of LDVT group were all higher than no-LDVT.3. The five Laboratory parameters associated with the Wells score analyzed:APTT, PT had no correlation with the Wells score, OR values were (0.157,0.134, P> 0.05); FG, D-dimer, vWF:Ag had correlation with Wells score, OR values were (0.627,0.675,0.532), (P<0.05)。4. Evaluated the accuracy of the diagnostic methods which FG, D-dimer, vWF:Ag combing with Wells score predicded and early diagnosed LDVT of postoperative orthopedic surgery pations. When Wells score<1, positive predictive value was 0%, negative predictive value of 100%, and the Wells score<1 and FG, D-dimer, vWF:Ag can be excluded LDVT;when 1(?)Wells score(?)2, positive predictive value was 62.5%, negative predictive value was 100%,and false positive rate was 37.5%, false negative rate was 0%; When Wells score(?)3,the positive predictive value was 92.5%, negative predictive value was 100%,false positive rate of 7.5%,and false negative rate was 0%.Conclusions1. FG, D-dimer, vWF:Ag of the pations'blood after major orthopedic operations were higher which was warning the occurrence of LDVT, and the higher their value were the greater likelihood of occurrence LDVT.2. When FG, D-dimer of the pations'blood after major orthopedic operations were negative and Wells score<1, it could exclude LDVT.3. Early detect FG,D-dimer,vWF:Ag of pations'blood after major orthopedic operations combined with assesse likelihood of the LDVT which could predict the LDVT occurrence.4. When FG,D-dimer,vWF:Ag were all positive and Wells score(?)3, it could diagnosis LDVT.