摘要
目的:探讨术前彩色多普勒超声(CDFI)筛查骨折患者下肢静脉血栓对防止肺栓塞的意义。方法:回顾性分析2010年1月至12月,因创伤致下肢骨折入院,拟行切开复位术的2000例患者,男1140例,女860例;年龄18～94岁,平均(54.78±21.45)岁。所有患者入院时伤肢肿胀明显,均经外敷和口服中药治疗,伤肢肿胀好转后(3～14d),行骨折复位术,手术前1d筛查骨折患者下肢血栓,并对其临床资料(性别、年龄、骨折部位、病程)进行回顾性分析。结果:①2000例创伤骨折患者术前经CDFI筛查,证实并发深静脉血栓(deepveinthrombosis,DVT)共128例(6.4%)。血栓类型:髂-股静脉血栓52例,腘-胫静脉血栓20例,小腿肌肉静脉血栓56例。对胫静脉以上DVT72例采取溶栓治疗或放置下腔静脉滤网,溶栓有效20例,放置下腔静脉滤网17例,溶栓失败和未放置腔静脉滤网患者28例,这65例均实施了骨折复位术,另外7例采取保守治疗。1例术中发生肺栓塞,经及时溶栓治疗获得成功。小腿肌肉静脉血栓56例中51例未行特殊处理,实施了复位术;另5例行保守治疗。②DVT发生与性别无关;血栓发生最小年龄22岁,41岁以上组血栓发生率高于40岁以下年龄组;多发骨折、股骨骨折高于胫骨、腓骨骨折;血栓发生病程最短3d,病程越长,血栓发生率越高。结论:创伤骨折患者无论是否存在形成DVT的高危因素,骨折复位手术前均应常规行CDFI筛查DVT,对降低麻醉、手术风险,防止致命性肺栓塞有重要意义。
Objective：To Explore the significance of preoperative screening of deep vein thrombosis（DVT） on the prevention from pulmonary embolism（PE） with color Doppler flow imaging （CDFI） in patients of lower limb fractures. Methods：A total of 2 000 patients with lower limb fractures were retrospectively analyzed from January to September in 2010. All the patients were scheduled to be operated. There were 1 140 males and 860 females,ranging in age from 18 to 94 years,with a mean of （54.78±21.45） years. Swollen limbs could be observed in all patients when admitted and traditional Chinese medicine therapies were given by both internal and external administrations. Selective internal or external fixations were scheduled 3 to 14 days after injured and the swell relieved. CDFI screenings for DVT were applied to all the patients one day before operations and clinical data,such as gender,age,fracture site and course of diseases,were analyzed. Results：Of all the 2 000 patients,128 patients had lower limbs DVTs（6.4%）. Among all the DVT patients,52 patients had DVT within vena iliacas or femoral veins,20 patients had DVT within popliteal veins or vena crualis,56 patients had DVT within small muscular veins of legs. Thrombolytic therapies or inferior vena cava filters were taken to 72 patients with DVTs proximal to vena cruralises and thrombi disappeared in 20 cases. Inferior vena cava filters were placed in 17 patients. There were 28 patients with either failed thrombolytic or no filters placement. All above 65 patients were treated with fracture reduction,and other 7 patients were treated with conservative methods. Of all the operated patients,one patient had PE during operation and recovered after immediately rescue. Among 56 patients with DVT within small muscular veins of legs,51 patients were treated with reduction without other special treatment,and other 5 patients were treated with conservative methods. There was no relationship between DVT occurrence and gender. The youngest sufferer was 22 years old. DVT occurrences of patients over 41 years old were significantly higher than that of patients under 40 years old. Higher occurrences were also observed in patients with multiple fractures,fracture of femurs compared with those with tibia or fibula fractures. DVT was found as early as 3 days after injury in one case. The longer the time from injuries to operations,the higher the occurrences of DVTs. Conclusion：Routine CDFI screenings should be applied to traumatic fractured patients before operations no matter whether there are DVTs existing or not. That is very important for the prevention of fatal PE during both anesthesias and operations.
出处
《中国骨伤》
CAS
2011年第9期754-756,共3页
China Journal of Orthopaedics and Traumatology
基金
广东省中医药管理局科研基金(编号:20007275)~~
关键词
超声检查
多普勒
彩色
骨折
静脉血栓形成
下肢
肺栓塞
Ultrasonography
Doppler
color
Fractures
Venous thrombosis
lower extremity
Pulmonary embolism
