| Objective: To investigate the distribution of distal deep venous thrombosis(DDVT)under anticoagulation in patients with lower extremity fracture in trauma and orthopedics department,and to evaluate the early changes of DDVT and the risk factors affecting the distribution type of DDVT.Methods: 892 patients with lower extremity fractures who underwent DDVT before surgery were retrospectively analyzed from January 2014 to December 2018 according to the inclusion criteria.Doppler ultrasonography of both lower deep veins was performed before and after operation respectively,the location of thrombus was recorded in detail,the incidence of thrombosis in different veins was counted,and the therapeutic effect of anticoagulant drugs on DDVT was evaluated by the change of DDVT location and outcome after operation.All DDVTs were divided into group A(thrombus involving only one vein or one anatomical site)and group B(thrombus involving two or more veins at the same time).The factors(Age,gender,fracture,fracture site,combined disease,BMI,surgical method,time from injury to hospital admission,time from injury to surgery,length of operation,blood transfusion,blood loss,transfusion volume,and preoperative and postoperative serum Indicators)related to the distribution type of DDVT in patients with lower extremity fractures were univariately analyzed,and then multivariate logistic regression equation was used for multivariate analysis to obtain risk factors.P <0.05 was considered statistically significant.Results: 892 patients with lower extremity fracture complicated with DDVT before surgery,761(85.31%)patients were in group A,including 674(88.57%)patients with muscular calf vein thrombosis,followed by 69(9.06%)patients with posterior tibial vein thrombosis and 18(2.37%)patients with peroneal vein thrombosis.131(14.69%)patients in group B,2 or 3 branches of muscular calf vein thrombosis,posterior tibial vein thrombosis and peroneal vein thrombosis were the most frequently involved at the same time.The thrombus disappeared in 209 patients after operation,the location of thrombus distribution did not change in 513 patients,DDVT changed from involving multiple veins to involving single vein in 34 patients,DDVT changed from involving multiple veins to involving proximal thrombus/mixed thrombus in 50 patients after operation,the extensionrate to proximal veins was 5.61%,and DDVT changed from involving single vein to involving multiple veins in in 86 patients.Among 633 patients of DDVT after surgery,485(76.62%)patients in group A included 459(94.64%)patients with muscular calf vein thrombosis,followed by 19(3.92%)patients with posterior tibial vein thrombosis and 7(1.44%)patients with peroneal vein thrombosis;148(23.38%)patients in group B,2 or 3branches of muscular calf vein thrombosis,posterior tibial vein thrombosis and peroneal vein thrombosis were the most frequently involved at the same time.There was a statistically significant difference between the type of DDVT distribution after surgery and the type of DDVT before surgery(P <0.001).Before surgery,402(45.07%)patients had DDVT in the left lower extremity,331(37.11%)patients had DDVT in the right lower extremity,and 159(17.82%)patients had DDVT in both lower extremities simultaneously;after surgery,244(35.72%)patients had DDVT in the left lower extremity,179(26.21%)patients had DDVT in the right lower extremity,and 260(38.07%)patients had DDVT in both lower extremities simultaneously.The distribution of DDVT after surgery was statistically different from that of DDVT before surgery(P <0.001).Before surgery,609(68.27%)patients had DDVT in the injured extremity,283(31.73%)patients had DDVT in the uninjured extremity,386(56.52%)patients had DDVT in the injured extremity,and297(43.48%)patients had DDVT in the uninjured extremity.The distribution of DDVT on the uninjured or injured extremities was statistically different from that before surgery(P <0.001).The time from injury to surgery(OR=1.086;95% CI 1.017-1.159;P=0.014)and D-dimer 1 day after surgery(OR=1.050;95% CI 1.020-1.081;P=0.001)were risk factors affecting the type of DDVT distribution before and after surgery,respectively.Conclusion: 1.The muscular calf vein is the most frequently affected location of DDVT in patients with lower extremity fractures during perioperative period.Among DDVT involving multiple veins,2 or 3 branches of muscular calf vein thrombosis,posterior tibial vein thrombosis and peroneal vein thrombosis were the most frequently involved at the same time.DDVT mostly occurs in the injured lower extremity,and there is also a high incidence of thrombosis in the uninjured lower extremity.2.The time from injury to surgery is an independent risk factor affecting the type of DDVT distribution in patients with lower extremity fracture before surgery.For patients with lower extremity fracture,the longer waiting time before surgery,the higher incidence of DDVT involving multiple veins.3.Anticoagulation treatment immediately after admission for lower extremity fracture patients without anticoagulation contraindications can make 57.51% of the DDVT position unchanged after surgery,27.24% of the DDVT decreased ordisappeared after surgery,and only 5.61% of the DDVT extended to the proximal deep vein after surgery.Early and active anticoagulation therapy can effectively stabilize the location of thrombosis,even reduce or disappear the formed DDVT,and effectively reduce the increase of DDVT and the rate of extension to the proximal vein in patients with lower extremities fracture after surgery,without fatal pulmonary embolism and serious bleeding events. |
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