Study On The Related Factors Of Deep Vein Thrombosis After Lower Limb Fracture

Objective: To clarify the related factors of perioperative period of patients with deep vein thrombosis after lower extremity fracture surgery,and to provide countermeasures for the early diagnosis and prevention of deep vein thrombosis after lower extremity fracture surgery in the department of orthopedics.Methods: The self designed clinical case questionnaire,the questionnaire of "Classification and Determination of Traditional Chinese Medicine Constitution" issued by China Association of Traditional Chinese Medicine and the electronic case system(Hiss system)were used for investigation.The patients who met the inclusion criteria were investigated in terms of general condition,perioperative condition,laboratory examination and traditional Chinese medicine constitution.Single factor and logistics regression were used for statistical analysis of data.Results:1.A total of 400 patients with lower extremity fracture were included in this study,among whom 38 patients developed deep vein thrombosis after surgery,with an incidence of 9.5%,and no patients developed pulmonary embolism.18 patients had thrombosis in unilateral limb intermuscular vein,and 3 patients(21 cases in total)had thrombosis in bilateral limb intermuscular vein,accounting for 55.26% of the total cases.The peroneal vein thrombosis occurred in one limb in 8 patients,and in 2 patients(10 cases in total),accounting for 26.32%of the total cases.4 patients had thrombosis in the posterior tibial vein of unilateral limbs and1 patient(5 cases in total)had thrombosis in the posterior tibial vein of bilateral limbs,accounting for 13.16% of the total cases.The number of thrombus occurred in more than two veins in 2 patients,accounting for 5.26% of the total cases.2.The lower limb fractures in patients with postoperative deep vein thrombosis and age,sex,body mass index,diabetes,high blood pressure,high cholesterol,smoking history,surgical duration,anesthesia,intraoperative blood loss,blood transfusion,applied a tourniquet,postoperative bed time,reasonable use of anticoagulant drugs,the use of negative pressure drainage and TCM constitution type comparative analysis,statistically significant difference(P < 0.05),all have obvious correlation.The elderly,women,obesity,diabetes,hypertension,hyperlipidemia,surgery > 2.5 hours,anesthesia(general anesthesia),intraoperative blood loss or 500 ml,blood transfusion,postoperative bed > 3 days to be lower limbs fracture independent risk factors for postoperative deep vein thrombosis,and reasonable application of anticoagulant drugs,the use of negative pressure drainage for fractures of postoperative deep vein thrombosis of lower limb protection factors.There was no significant difference between the occurrence of deep vein thrombosis after lower extremity fracture and the fracture site and drinking history of the patients(P> 0.05),and there was no significant correlation.3.The postoperative rates of deep vein thrombosis at different fracture sites were 18.42% of hip joint,13.16% of femur,13.16% of knee joint,26.32% of tibia and fibula,10.53% of ankle joint and 18.42% of foot.4.Comparison of laboratory indicators between the venous thrombosis group and the non-thrombosis group after lower extremity fracture surgery: the values of hemoglobin and albumin plasma fibrinogen in the postoperative thrombosis group were lower than those in the non-thrombosis group,and the differences were statistically significant(P<0.05).Plasma prothrombin time,activated partial thromboplastin time and plasma D-dimer values in the thrombosis group were higher than those in the non-thrombosis group,and the differences were statistically significant(P<0.05).5.TCM constitution: There was statistical significance in the incidence of DVT among different TCM constitution types(P<0.05).Further analysis showed that deep vein thrombosis was more common in patients with Qi-deficiency and blood stasis after lower limb fracture.Conclusion:1.In this study,the incidence of deep vein thrombosis after lower extremity surgery was9.5%,which was mainly the single intermuscular vein in one limb.2.Age,sex,body mass index,diabetes,high blood pressure,high cholesterol,smoking history,reasonable use of anticoagulant drugs,surgical duration,anesthesia,intraoperative blood loss,blood transfusion,applied a tourniquet,the use of negative pressure drainage,postoperative bed time,traditional Chinese medicine physique were fractures related factors of postoperative deep vein thrombosis of lower limbs,including age,women,obesity,diabetes,hypertension,hyperlipidemia,surgical duration > 2.5 h,general anesthesia,intraoperative blood loss or 500 ml,blood transfusion,postoperative bed time > 3 days are lower limb fracture independent risk factors for postoperative deep vein thrombosis,Rational use of anticoagulant drugs and negative pressure drainage are the protective factors of deep vein thrombosis after lower limb fracture.3.Among the fractures of lower limbs,the incidence of deep vein thrombosis after tibiofibular fractures is the highest.4.Continuous and dynamic monitoring of pre-operative and postoperative hemoglobin(HGB),albumin(ALB),plasma prothrombin time(PT),plasma fibrinogen(FIB),activated partial thromboplastin time(APTT),plasma D-dimer(D-D)and other relevant indexes is conducive to the early diagnosis and treatment of deep vein thrombosis after lower limb fracture.5.This study found that deep vein thrombosis(DVT)was more common in patients with Qi-deficiency and blood stasis after lower extremity fracture.