發(fā)布時間：2018-06-20 22:26

  本文選題：下肢骨折 + 深靜脈�。� 參考：《山西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:本課題只回顧性研究我院下肢單一部位閉合性骨折患者術(shù)前深靜脈血栓的發(fā)生率,分析下肢骨折術(shù)前深靜脈血栓的發(fā)生與D-二聚體動態(tài)變化的相關(guān)性研究。方法:回顧性分析山西大醫(yī)院2011年11月到2013年12月下肢骨折患者的臨床資料:體重指數(shù)、術(shù)前臥床時間、骨折后早期(3d)及術(shù)前長時間臥床(7d)監(jiān)測D-二聚體結(jié)果、下肢深靜脈超聲檢查的結(jié)果等。依據(jù)所有納入病例的術(shù)前下肢深靜脈超聲檢查結(jié)果,統(tǒng)計我院下肢單一部位閉合性骨折患者術(shù)前深靜脈血栓的發(fā)生率,并依據(jù)術(shù)前超聲結(jié)果將納入患者分為非DVT組與DVT組,并對兩組間骨折后24h內(nèi)的D-D檢查結(jié)果、術(shù)前D-D峰值、D-D峰值出現(xiàn)時間等指標(biāo)進行統(tǒng)計分析和比較。P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:(1)下肢單一部位閉合性骨折患者術(shù)前臥床超過7天的DVT發(fā)生率要高于臥床少于7天的DVT發(fā)生率,且差異具有統(tǒng)計學(xué)意義(P0.05)。(2)DVT組與非DVT組在傷后24h內(nèi),D—二聚體含量比較差異顯著有統(tǒng)計學(xué)意義(P0.05),但是DVT組與非DVT組之間的D—二聚體峰值比較差異無統(tǒng)計學(xué)意義。(3)骨折后前3d內(nèi),非DVT組D—二聚體達到峰值的患者比例明顯高于DVT組,且差異具有統(tǒng)計學(xué)意義(P0.05)。(4)下肢單一部位閉合性骨折患者術(shù)前深靜脈血栓發(fā)生的相關(guān)危險因素分析結(jié)果如下:臥床時間7天、骨折后早期(3d)凝血檢查中D-二聚體連續(xù)性增高,不出現(xiàn)下降趨勢即峰值出現(xiàn)較晚的患者發(fā)生深靜脈血栓的風(fēng)險明顯增大;年齡、性別、BMI、入院診斷等對下肢單一部位閉合性骨折患者術(shù)前深靜脈血栓發(fā)生的影響不顯著。結(jié)論:1.山西大醫(yī)院骨科下肢單一部位閉合性骨折患者深靜脈血栓(LDVT)發(fā)生率為17.8%。2.術(shù)前長時間臥床(7d)和早期(3d)D-二聚體動態(tài)連續(xù)升高,為下肢單一部位閉合性骨折患者術(shù)前DVT發(fā)生的危險因素。3.不同類型骨折術(shù)前LDVT發(fā)生率不相同,其中股骨頸骨折深靜脈血栓的發(fā)生率最高、為35.71%,但是差異沒有統(tǒng)計學(xué)意義。4.單次D-D檢測不足以判斷LDVT的形成;D-D連續(xù)檢測判斷LDVT可能成為一種趨勢。
[Abstract]:Objective: to study the incidence of deep venous thrombosis (DVT) in patients with closed fracture of lower extremity in our hospital, and to analyze the correlation between DVT and dynamic changes of D-dimer. Methods: the clinical data of patients with lower extremity fracture from November 2011 to December 2013 in Shanxi Great Hospital were retrospectively analyzed. Body mass index (BMI), bedrest time before operation, early period after fracture (3 days) and prolonged bedrest before operation (7 days) were analyzed to monitor the results of D-dimer. Results of ultrasound examination of deep vein of lower extremity. The incidence of preoperative deep venous thrombosis in patients with closed fracture of lower extremity in our hospital was counted according to the results of preoperative deep vein ultrasound examination in all patients. According to the results of preoperative ultrasound, the patients were divided into non-DVT group and DVT group. The results of D-D examination within 24 hours after fracture between the two groups, the time of D-D peak and D-D peak before operation were statistically analyzed and compared. P05 was statistically significant. Results (1) the incidence of DVT in patients with closed fracture of single part of lower extremity was higher than that in patients who stayed in bed for more than 7 days before operation. There was significant difference in D- dimer content between DVT group and non-DVT group within 24 hours after injury, but there was no significant difference between DVT group and non-DVT group in D- dimer peak value within 3 days after fracture. The proportion of patients with peak D-dimer in non-DVT group was significantly higher than that in DVT group. The risk factors of deep venous thrombosis in patients with single closed fracture of lower extremity were analyzed. The results were as follows: 7 days stay in bed, 3 days after fracture) the continuity of D-dimer was increased in coagulation examination. The risk of deep venous thrombosis in patients with late peak value was significantly increased, while age, sex, and admission diagnosis had no significant effect on the occurrence of deep venous thrombosis in patients with closed fracture of lower extremity at single site before operation. Conclusion 1. The incidence of deep venous thrombosis (LDVT) in patients with closed fracture of lower extremity in orthopaedic department of Shanxi Great Hospital was 17.8%. Prolonged preoperative bed rest for 7 days) and early dynamic elevation of D-dimer were risk factors of DVT in patients with closed fracture of lower extremity. The incidence of LDVT in different types of fractures was different before operation, and the incidence of deep vein thrombosis in femoral neck fracture was the highest (35.71%), but the difference was not statistically significant. 4. The single D-D detection is not enough to judge the formation of LDVT. It may be a trend to judge LDVT by D-D continuous detection.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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