Incidence And Risk Factors Of Deep Venous Thrombosis Of Lower Extremity In Patients With The Fracture Around Knee Joint

Objective:To investigate the incidence and risk factors of deep venous thrombosis(DVT)of lower extremity in patients with the fracture around knee joint.Methods:A retrospective analysis of 416 patients with fractures of the knee around the period from September 2015 to September 2018,the 416 patients met the inclusion criteria.Patients were divided into a thrombus group and a non-thrombosis group according to the presence or absence of DVT during hospitalization.All patients underwent RAPT scores in the hospital.The low-risk group received mechanical treatment of the plantar venous pump.The patients in the middle-high-risk group were given LMWH after excluding anticoagulation contraindications,and were treated with a plantar venous pump.The plasma D-dimer concentration was measured at admission,1 day before surgery,l day,3 days after surgery,and 5 days after surgery.The incidence of DVT was determined by venous ultrasound of both lower limbs before and after surgery.And gender,fracture type,combined medical disease,combined with other parts of the injury,age,injury to surgery time,anesthesia classification(ASA classification),time spent on surgery,tourniquet use time,blood loss,infusion Volume,body mass index(BMI),hospitalized hemoglobin(Hemoglobin,HGB),1d postoperative hemoglobin,D-dimer of admission,D-dimer of preoperative,1d D-dimer of postoperative,postoperative 3d D-dimerization Statistical analysis was performed on factors such as body factors.Univariate analysis was used to screen for risk factors,and multivariate logistic regression analysis was used to determine the main independent risk factors.P <0.05 considered the difference to be statistically significant.Results:A total of 416 patients,231 males and 185 females,had a male-female ratio of 1.3:1;the age ranged from 18 to 91 years,with an average age of 51.1 ± 14.8 years.There were 178 cases of humeral fracture,203 cases of tibial plateau,16 cases of femoral condyle,and 19 cases of femoral condyle.The incidence of DVT in the lower limbs was 52.2%,and the preoperative and postoperative DVT rates were 35.1% and 38.5%,respectively(P=0.000).Incidence of DVT in patients with tibial fractures,tibial plateau fractures,intercondylar fractures and supracondylar fractures was 16.8%,29.6%,3.4%,and 2.4%,respectively.The incidence of DVT was the highest in the tibial plateau fracture during hospitalization,and the highest incidence of DVT in the tibial plateau fracture(P=0.000).DVT occurs in the left lower limb and is mainly composed of distal intramuscular venous thrombosis;DVT can also occur in the uninjured limb.The incidence of DVT in the uninjured limb before and after surgery is 4.3% and 7.2%,respectively.BMI and hospitalized hemoglobin were risk factors for uninjured limb DVT in patients with the fracture around knee joint(P <0.05);age,anesthesia grade,thrombus type,fracture site,and D-dimer after 3 days postoperatively Risk factors for uninjured limb DVT(P < 0.05).Age>60 years old,fracture type,blood loss,blood transfusion volume,preoperative 1d D-dimer positive,postoperative 1d D-dimer positive,postoperative 3d D-dimer positive,RAPT score was occurred in patients with the fracture around knee joint risk factors for DVT(P <0.05);fracture type,age >60 years,preoperative 1d D-dimer positive was an independent risk factor for DVT in patients with the fracture around knee joint(P <0.05).The ROC curve shows that when the diagnostic threshold of D-dimer is 3.3 mg/L,the AUC area is the largest,which is 0.739.At this time,the specificity occupied 25%.and the sensitivity occupied 63%.Conclusion:Incidence of DVT in the lower limbs was 52.2%,and the preoperative and postoperative DVT rates were 35.1% and 38.5%,respectively.The incidence of postoperative DVT increased compared with preoperative.The incidence of DVT in patients with tibial fractures,tibial plateau fractures,intercondylar fractures and supracondylar fractures was 16.8%,29.6%,3.4%,and 2.4%,respectively.The incidence of DVT was the highest in the tibial plateau fracture during hospitalization.Finding DVT in the left lower extremity,with distal intermuscular venous thrombosis;DVT can also occur in the uninjured limbs.The incidence of DVT in the uninjured limbs before and after surgery is 4.3% and 7.2%,respectively.Clinically,preventing and treatment when the limb DVT is affected,the uninjured limb should also be routinely examined.BMI and hospitalized hemoglobin are risk factors for uninjured limb DVT in patients with preoperative knee fractures;age,anesthesia grade,thrombus type,fracture site,and 3-day postoperative D-dimer are risk factors for postoperative uninjured limb DVT.Age>60 years old,fracture type,blood loss,blood transfusion volume,preoperative 1d D-dimer positive,postoperative 1d D-dimer positive,postoperative 3d D-dimer positive,RAPT score was occurred in patients with the fracture around knee joint risk factors for DVT;fracture type,age > 60 years,preoperative 1d D-dimer positive is an independent risk factor for DVT in patients with the fracture around knee joint.When the diagnostic threshold of D-dimer is 3.3 mg/L,the sensitivity and specificity of diagnosis of DVT are higher at this time.After clinical DVT in patients with the fracture around knee joint,both the importance and prevention strategies should be emphasized,and different preventive measures and treatment methods should be adopted for different situations,can effectively reduce the incidence of DVT and the incidence of fatal pulmonary embolism events.