The Value of Coagulation-Related Indicators Combined with Vascular Ultrasound Parameters in the Risk Assessment of Deep Vein Thrombosis after Secondary Traumatic Fracture Surgery

IF 0.9 4区医学 Q3 SURGERY

Annali italiani di chirurgia Pub Date : 2024-04-20 DOI:10.62713/aic.3177

Yaoyao Deng, Xuan Luo, Xin Xu

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引用次数: 0

Abstract

Objective: The incidence of deep vein thrombosis (DVT) after traumatic fracture is high, and DVT causes serious adverse effects on the postoperative recovery of patients. The purpose of this study was to explore the effect of coagulation-related indicators combined with vascular ultrasound measurements for the risk assessment of DVT after secondary traumatic fracture, and to provide a new method for predicting the occurrence of DVT. Methods: The clinical data of patients with secondary traumatic fracture surgery in our hospital from January 2019 to January 2022 were retrospectively analyzed. The patients were divided into a non-DVT group and a DVT group according to whether DVT was indicated in the medical record system. The coagulation-related indices and vascular ultrasound measurements of the two groups were compared, and the risk factors for postoperative DVT were analyzed by bivariate correlation and multivariate logistic regression. Results: According to the medical record system, 55 patients (47.41%) had DVT, and 61 patients (52.59%) did not have DVT. There was no significant difference in prothrombin time (PT) or activated partial thromboplastin time (APTT) between the two groups (p > 0.05). The thrombin time (TT) in the DVT group was lower than that in the non-DVT group. The levels of fibrinogen (FIB) and D-dimer (D-D) in the DVT group were higher than those in the non-DVT group (t = 2.766, 3.242, 2.649, p = 0.007, 0.002, 0.009). Spearman correlation analysis showed that peak systolic velocity (Vs), end-diastolic velocity (Vd), pulsatility index (PI), resistance index (RI), FIB, and D-D were positively correlated with the risk of DVT after secondary traumatic fracture surgery (r = 0.264, 0.656, 0.293, 0.276, 0.287, 0.251, p < 0.05). TT was negatively correlated with DVT risk after secondary traumatic fracture surgery (r = –0.249, p < 0.05). The measurements of peak systolic velocity (Vs), end diastolic velocity (Vd), pulsatility index (PI) and resistance index (RI) in the DVT group were higher than those in the non-DVT group (t = 2.663, 2.998, 3.135, 2.953, p = 0.009, 0.003, 0.002, 0.004). FIB, D-D, Vs, Vd, PI, and RI were independent risk factors for DVT after secondary traumatic fracture surgery (Odds Ratio (OR) = 1.483, 2.026, 2.208, 1.893, 1.820, 1.644, p < 0.05). TT index was an independent protective factor for DVT after secondary traumatic fracture surgery (OR = 0.868, p < 0.05). The sensitivity and specificity for prediction of DVT based on combined coagulation-related indicators and vascular ultrasound imaging measurements were higher than those of individual measurements (p < 0.05). Conclusions: Coagulation-related indicators and vascular ultrasound parameters can effectively predict the formation of DVT. Through the analysis of factors related to DVT formation, screening of high-risk patients for effective intervention may help to reduce the risk of DVT. Further verification in additional, large-scale clinical trials is advocated.

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凝血相关指标与血管超声参数相结合在创伤性骨折二次手术后深静脉血栓形成风险评估中的价值

目的：创伤性骨折后深静脉血栓形成（DVT）的发生率很高，DVT对患者术后恢复造成严重不良影响。本研究旨在探讨凝血相关指标结合血管超声测量对继发性创伤骨折后深静脉血栓风险评估的影响，为预测深静脉血栓的发生提供一种新方法。方法回顾性分析我院2019年1月至2022年1月继发性创伤骨折手术患者的临床资料。根据病历系统中是否注明深静脉血栓形成，将患者分为非深静脉血栓形成组和深静脉血栓形成组。比较两组患者的凝血相关指标和血管超声测量结果，并通过双变量相关性和多变量逻辑回归分析术后深静脉血栓的风险因素。结果根据病历系统显示，55 名患者（47.41%）有深静脉血栓，61 名患者（52.59%）没有深静脉血栓。两组患者的凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）无明显差异（P>0.05）。深静脉血栓组的凝血酶时间（TT）低于非深静脉血栓组。DVT 组的纤维蛋白原（FIB）和 D-二聚体（D-D）水平高于非 DVT 组（t = 2.766、3.242、2.649，P = 0.007、0.002、0.009）。斯皮尔曼相关性分析显示，收缩期峰值速度（Vs）、舒张末期速度（Vd）、搏动指数（PI）、阻力指数（RI）、FIB和D-D与继发性创伤骨折手术后发生深静脉血栓的风险呈正相关（r = 0.264、0.656、0.293、0.276、0.287、0.251，P < 0.05）。TT与继发性创伤骨折手术后的深静脉血栓风险呈负相关（r = -0.249，p < 0.05）。深静脉血栓组的收缩峰值速度（Vs）、舒张末期速度（Vd）、搏动指数（PI）和阻力指数（RI）均高于非深静脉血栓组（t = 2.663、2.998、3.135、2.953，p = 0.009、0.003、0.002、0.004）。FIB、D-D、Vs、Vd、PI 和 RI 是继发性创伤骨折手术后深静脉血栓形成的独立危险因素（Odds Ratio (OR) = 1.483、2.026、2.208、1.893、1.820、1.644，P < 0.05）。TT指数是继发性创伤骨折手术后深静脉血栓形成的独立保护因素（OR = 0.868，P < 0.05）。综合凝血相关指标和血管超声成像测量结果预测深静脉血栓的敏感性和特异性均高于单独测量结果（P < 0.05）。结论凝血相关指标和血管超声参数可有效预测深静脉血栓的形成。通过分析深静脉血栓形成的相关因素，筛查高危患者并进行有效干预，有助于降低深静脉血栓形成的风险。建议在更多的大规模临床试验中进一步验证。

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来源期刊

Annali italiani di chirurgia 医学-外科

CiteScore

0.90

自引率

12.50%

发文量

116

审稿时长

>12 weeks

期刊介绍： Annali Italiani di Chirurgia is a bimonthly journal and covers all aspects of surgery:elective, emergency and experimental surgery, as well as problems involving technology, teaching, organization and forensic medicine. The articles are published in Italian or English, though English is preferred because it facilitates the international diffusion of the journal (v.Guidelines for Authors and Norme per gli Autori). The articles published are divided into three main sections:editorials, original articles, and case reports and innovations.