骨创伤后深静脉血栓形成的危险因素分析

摘要

目的 探讨骨创伤后深静脉血栓形成(deep vein thrombosis,DVT)的危险因素.方法 选择创伤骨折患者118例(创伤骨折组)、经彩色多普勒确诊的DVT患者21例(DVT组)以及体检健康56例(对照组)作为研究对象.ELISA法检测抗心磷脂抗体(anti-crdiolipin antibody,ACA),血凝仪检测D-二聚体、纤维蛋白原(Fib),速率散射比浊法检测C反应蛋白(CRP).结果 创伤骨折组D-二聚体、Fib和CRP含量显著增高,但低于DVT组,DVT组ACA阳性率明显增高,创伤骨折组3例ACA阳性均发生DVT.下肢骨折组、多发骨折组、骨盆骨折组Fib、D-二聚体及CRP阳性率均高于上肢骨折组(P＜0.05).随着年龄增长,Fib和D二聚体逐渐增高,经溶栓治疗后,DVT组Fib和D-二聚体的含量均有不同程度降低. 结论 ACA阳性,D-二聚体、Fib和CRP升高是骨创伤后发生DVT的危险因素.骨创伤患者Fib和D-二聚体的含量与患者年龄有关,年龄越大,创伤后发生DVT的风险越高.%Objective To investigate the risk factors for deep vein thrombosis (DVT) after bone trauma.Methods The study involved 118 patients with traumatic fractures (traumatic fracture group),21 DVT patients diagnosed by color Doppler (DVT group) and 56 healthy patients (control group).Anti-cardiolipin antibody (ACA) was determined by ELISA method.D-dimer and fibrinogen (Fib) were detected by coagulation analyzer and C-reactive protein (CRP) by rate nephelometry.Results Levels of D-dimer,Fib and CRP in traumatic fracture group were significantly increased,but were lower than those in DVT group.ACA positive rate in DVT group presented significant increase and three patients with positive ACA in traumatic fracture group all suffered from DVT.The positive rates of Fib,D-dimer and CRP in lower limb fracture group,multiple fracture group and pelvic fracture group were higher than those in upper limb fracture group (P ＜ 0.05).Levels of Fib and D-dimer showed gradual rise with growth of age,but their levels in DVT group had different degree of reduction after thrombolytic therapy.Conclusions Positive ACA and enhancement of D-dimer,Fib and CRP are risk factors for DVT after bone trauma.Levels of Fib and D-dimer in patients with bone trauma are related with age and therefore risk of posttraumatic DVT increases with age.