| Objective To find out the data which have statistical significance to the formation of deep vein thrombosis in the data of middle-aged and old patients with proximal femoral fracture(to be replaced with hip joint).To explore the condition of DVT by B-mode color Doppler ultrasound.Methods From August 2015 to December 2019,patients with proximal femoral fracture(femoral neck fracture and intertrochanteric fracture)who were to be treated with hip replacement in our hospital were analyzed retrospectively.Collect the first blood test results of patients: hematocrit,hemoglobin,D-dimer,prothrombin time,platelet count,fibrin degradation products,activated partial thromboplastin time,thrombin time;(2)fracture data: fracture location,fracture type,fracture duration;(3)body mass index,age,gender;(4)results of B-type color Doppler ultrasound of lower extremity blood vessels.Quantitative data were analyzed by t-test and qualitative data were analyzed by chi square test.The influencing factors of preoperative DVT were analyzed by logistic regression.The ratio was used to measure the effect of influencing factors on preoperative DVT.The critical value of statistically significant factors and the area under the curve(AUC)were determined by the ROC curve of the subjects,and the critical value of statistically significant factors was determined by the Jordan index.The SPSS 22.0 software of SPSS company of the United States was used to analyze the data of patients with proximal femoral fracture.The counting data was expressed by(mean ± standard deviation),and the test level was ? = 0.05.Results There were 170 patients with proximal femoral fracture,103 with femoral neck fracture and 67 with intertrochanteric fracture.The type of fracture(femoral neck fracture / intertrochanteric fracture)(P = 0.706)was not statistically significant,which was not a significant factor in the detection of DVT of lower extremity by color Doppler ultrasound.(1)103 cases of femoral neck fracture were included in the study.72 cases had no DVT before operation and 31 cases had DVT before operation.There was no significant difference in preoperative D-Dimer(P = 0.161),BMI(P = 0.841),age(P =0.321)between the two groups.Hematocrit(P = 0.019)and fracture duration(P =0.022)were statistically significant.According to the binary logistic regression model,preoperative D-Dimer(P = 0.157),BMI(P = 0.812)and age(P = 0.316)were not the significant influencing factors of B-mode color Doppler ultrasound in the diagnosis of DVT of lower extremity,while the influencing factors of color Doppler ultrasound in the diagnosis of DVT of lower extremity were hematocrit(P = 0.019)and fracture duration(P = 0.002),which had statistical significance.Furthermore,according to the binary logistic regression model,hematocrit(or = 0.907,or = 0.907,or = 0.907,or =0.907,or = 0.907,or = 0.907),The significant risk factor of DVT of lower extremity before operation was fracture duration(or = 1.006,P = 0.009),and the relationship between fracture duration and hematocrit was determined: DVT index = 2.664-0.098× preoperative hematocrit(%)+ 0.006 × fracture duration(hours).The area under ROC curve of fracture duration was 0.660,the best critical value was 16.5h,the sensitivity was 74.2%,the specificity was 52.8%;the area under ROC curve of hematocrit(%)before operation was 0.363,the best critical value was 37%,the sensitivity was 58.1%,the specificity was 12.5%;the area under ROC curve of DVT index was 0.697,the best critical value was-1.0725,the sensitivity was 74.2%,the specificity was 63.9%.(2)Sixty seven patients with intertrochanteric fracture were included in the study.The number of patients with and without DVT was 22 and 45 respectively.There was no significant difference in preoperative D-Dimer(P = 0.466),BMI(P = 0.859)and age(P = 0.869)between the two groups.Hematocrit(P = 0.018)and fracture duration(P =0.002)were statistically significant.According to the binary logistic regression model,preoperative D-Dimer(P = 0.301),BMI(P = 0.857)and age(P = 0.866)were not the significant influencing factors of DVT,while the influencing factors of CDU in diagnosis of DVT were hematocrit(P = 0.018)and fracture duration(P = 0.000),which had statistical significance.According to the binary logistic regression model,the significant protective factor of DVT was hematocrit(or = 0.860,The significant risk factor of DVT of lower extremity before operation was fracture duration(or =1.045,P = 0.001),and the relationship between fracture duration and hematocrit was determined: DVT index = 3.284-0.151 × hematocrit before operation(%)+ 0.044× fracture duration(hours).The area under ROC curve of fracture duration was0.834,the best critical value was 6.5h,the corresponding sensitivity was 95.5%,the corresponding specificity was 57.8%;the area under ROC curve of hematocrit(%)before operation was 0.321,the best critical value was 34.7%,the sensitivity was27.3%,the specificity was 37.8%;The area under ROC curve of DVT index was0.862,the best critical value was-0.0058,the sensitivity was 63.6%,the specificity was 93.3%.Conclusion Hematocrit is a significant protective factor of DVT in patients with proximal femoral fracture(femoral neck fracture and intertrochanteric fracture),and fracture duration is a significant risk factor of DVT,and hematocrit has a greater effect on DVT.DVT index was used to predict the risk of DVT in lower extremity before operation.(1)Patients with femoral neck fractures:DVT index = 2.664-0.098 × preoperative hematocrit(%)+ 0.006 × fracture duration(hours).Before operation,the condition of color Doppler ultrasound diagnosis of lower extremity DVT: DVT index of patients ?-1.0725;in other cases,whether to use color Doppler ultrasound of lower extremity is decided by the clinician according to the patient's condition.(2)Patients with intertrochanteric fractures of the femur:DVT index = 3.284-0.151 ×preoperative hematocrit(%)+ 0.044 × fracture duration(hours).The conditions for preoperative diagnosis of lower extremity DVT with color Doppler ultrasound: DVT index of patients ?-0.0058;in other cases,whether to use color Doppler ultrasound of lower extremity is decided by the clinician according to the patient's condition. |
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