Occurrence Time And Location Of Lower Extremity Deep Venous Thrombosis In Patients With Fracture Around Knee Joint

Objective: To study the occurrence time and location of deep venous thrombosis(Deep Venous Thrombosis,DVT)in patients with fracture around knee joint.Methods: A prospective cohort study was used to collect the clinical data of patients with peri-knee fracture within 24 hours treated in the Bone Trauma Hospital of Honghui Hospital affiliated to Medical College of Xi’an Jiaotong University from September 2017to December 2020.In strict accordance with the inclusion and exclusion criteria,patients were required to complete the first ultrasonographic examination of the veins of both lower extremities within 24 hours after injury.According to the results of the first ultrasound,they were divided into group A(with DVT)and group B(without DVT).Group A was given therapeutic dose of anticoagulation.Group B was randomly divided into preventive anticoagulation group and natural observation group.Patients in preventive anticoagulation group were given preventive anticoagulation combined with physical prophylaxis,while patients in natural observation group were only given physical prophylaxis.All patients were examined by lower limb vein ultrasound every day from admission to discharge,and the patients using anticoagulants stopped within 12 hours before operation and 12 hours after operation.The data of patients were collected and analyzed by SPSS19.0 statistical software.Results: A total of 132 patients were included in this study,including 77 males and 55 females,with an average age of 53.35 ±16.75 years.The results of the first ultrasound on admission showed that 17.42% of the patients had DVT,82.58% but not DVT.The total incidence of DVT in the prophylactic anticoagulation group was 39.26%,while that in the natural observation group was 46.43%.The incidence of DVT before and after operation in the prophylactic anticoagulation group was 16.98% and 37.74% respectively,while that in the natural observation group was 17.86% and 46.43% respectively.There was no significant difference between the two groups(P > 0.05).In the preventive anticoagulation group and the natural observation group,the incidence of DVT before and after operation of supracondylar and intercondylar fracture of femur was the highest,which was higher than that of patellar fracture and tibial plateau fracture.The number of new cases of DVT at 5 days after injury and 5 days after operation were 23,13,4,1,1,16,8,3,1and 0respectively.10% of all DVT were mixed thrombus,90% were distal thrombus,no proximal thrombus appeared,and the incidence of intermuscular was the highest in distal thrombus.The thrombus involved 82.86% of the affected limbs and 17.14% of the contralateral limbs.The highest incidence of mixed thrombosis during hospitalization in group A was 17.39%.Age,coronary heart disease,increased D-dimer on admission were independent risk factors for DVT 24 h after injury in multivariate regression analysis(P<0.05).Conclusion: 1.The incidence of postoperative DVT in patients with peri-knee joint fracture was significantly higher than that before operation.Attention should be paid to the screening of postoperative DVT,and the highest incidence DVT supracondylar and intercondylar fractures of femur should also be paid more attention to.The incidence of preoperative and postoperative DVT in prophylactic anticoagulant group and natural observation group was similar,and anticoagulant drugs did not completely reduce the risk of DVT occurrence.2.The number of new cases of DVT was the highest in the first 2 days after injury and 2 days after operation,which should be screened by ultrasound.3.The proportion of middle and distal thrombus in all DVT was mainly intramuscular venous thrombosis,and the healthy limb could also occur DVT,should encourage the patient to exercise more healthy limbs.4.The incidence of mixed thrombus in group A was the highest.Age,coronary heart disease and increased D-dimer on admission were independent risk factors for DVT within 24 hours after injury.Timely detect dangerous thrombosis and give appropriate measures to avoid pulmonary embolism.