中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (36): 5845-5849.doi: 10.12307/2023.729

• 骨科植入物相关临床实践 Clinical practice of orthopedic implant • 上一篇    下一篇

五种血栓评估表对股骨转子间骨折深静脉血栓形成的预测价值

向飞帆1，2，范  玮1，2，魏代清1，2，梁  杰1，2，叶俊武1，2，阳运康1，2   

  1. 1西南医科大学附属医院骨科，四川省泸州市   646000；2四川省骨科置入器械研发应用技术工程实验室，四川省泸州市   646000
  • 收稿日期:2022-09-26 接受日期:2022-11-16 出版日期:2023-12-28 发布日期:2023-03-25
  • 通讯作者: 阳运康，博士，教授，硕士生导师，西南医科大学附属医院骨科，四川省泸州市 646000；四川省骨科置入器械研发应用技术工程实验室，四川省泸州市 646000
  • 作者简介:向飞帆，男，1990年生，四川省安岳县人，汉族，2017年西南医科大学毕业，硕士，主治医师，主要从事四肢创伤修复与老年髋部骨折方面的研究。
  • 基金资助:
    四川省科技厅课题(2022NSFSC1534)，项目负责人：向飞帆；泸州市科技局课题(2021-JYJ-60)，项目负责人：阳运康；泸县人民政府-西南医科大学联合课题(2020LXXNYKD-03)，项目负责人：阳运康

Predictive value of five thrombotic risk assessment scales for deep vein thrombosis after intertrochanteric fracture of the femur

Xiang Feifan1, 2, Fan Wei1, 2, Wei Daiqing1, 2, Liang Jie1, 2, Ye Junwu1, 2, Yang Yunkang1, 2   

  1. 1Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China; 2Sichuan Orthopedic Implantation Device Research & Development Application Technology Engineering Laboratory, Luzhou 646000, Sichuan Province, China
  • Received:2022-09-26 Accepted:2022-11-16 Online:2023-12-28 Published:2023-03-25
  • Contact: Yang Yunkang, MD, Professor, Master’s supervisor, Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China; Sichuan Orthopedic Implantation Device Research & Development Application Technology Engineering Laboratory, Luzhou 646000, Sichuan Province, China
  • About author:Xiang Feifan, Master, Attending physician, Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China; Sichuan Orthopedic Implantation Device Research & Development Application Technology Engineering Laboratory, Luzhou 646000, Sichuan Province, China
  • Supported by:
    Sichuan Provincial Science and Technology Department Project, No. 2022NSFSC1534 (to XFF); a Grant from Luzhou Science and Technology Bureau, No. 2021-JYJ-60 (to YYK); the Joint Project of Luxian County People’s Government-Southwest Medical University, No. 2020LXXNYKD-03 (to YYK)

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摘要：


文题释义：

受试者工作特征曲线：又称ROC(receiver operating characteristic curve)曲线，ROC曲线下面积是指ROC曲线与x轴、(1，0)-(1，1)围绕的面积，曲线下面积大于0.5，证明该诊断试验具有一定的诊断价值。同时，曲线下面积越接近1，离(0，1)点越近，证明诊断试验的真实性越好。
95%可信区间(95%CI)：是用来估计参数的取值范围的方法。比如在用样本估计整体均值的实验过程中，假设做了100组统计均值实验后，算出95%CI后，其中有95个可信区间包含整体均值，5个不包含。

背景：股骨转子间骨折并发下肢深静脉血栓形成，一旦脱落导致肺栓塞可能危及生命。目前临床可用的深静脉血栓形成评估量表较多，但其在股骨转子间骨折患者中的应用价值尚未明确。
目的：比较 5种血栓风险评估量表对股骨转子间骨折患者下肢深静脉血栓形成发生的预测价值。
方法：对西南医科大学附属医院骨科2016年7月至2021年7月收治的254例股骨转子间骨折住院患者资料进行回顾性分析，依据下肢静脉彩超检查结果，分为深静脉血栓形成组和非深静脉血栓形成组，依次选用Capprini、RAPT、Autar、Pauda及Wells量表对患者发生深静脉血栓形成的风险进行评定，比较两组患者5种血栓风险评估量表的评分；同时绘制受试者工作特征曲线，计算曲线下面积，分析5种血栓风险评估量表对股骨转子间骨折患者下肢深静脉血栓形成发生的预测价值。

结果与结论：①深静脉血栓形成组患者的Wells评分、Autar评分及RAPT评分明显高于非深静脉血栓形成组(P < 0.05)；②Wells、Capprini、RAPT、Autar、Pauda评分量表的曲线下面积分别为0.916，0.751，0.767，0.544及0.575；③Wells、Capprini、RAPT、Autar、Pauda评分量表诊断股骨转子间骨折患者发生深静脉血栓形成的灵敏度分别为93.22%，77.97%，74.01%，58.76%及36.16%，特异度分别为64.94%，59.74%，35.06%，49.35%及74.03%；④上述5种血栓风险评估量表对股骨转子间骨折住院患者下肢深静脉血栓形成发生均有一定预测价值，但Wells风险评估量表预测价值相对较高，其次是Capprini与RAPT评估量表；Wells量表针对股骨转子间骨折住院患者发生血栓的风险评估价值较为准确，RAPT量表针对所有创伤骨科患者发生血栓的风险评估较为适用。

https://orcid.org/0000-0001-9019-5515 (向飞帆)；https://orcid.org/0000-0002-8486-3932 (阳运康)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 深静脉血栓形成, 股骨转子间骨折, 评分量表, 预测价值, 受试者工作特征曲线, 风险评估

Abstract: BACKGROUND: Once the deep vein thrombosis of the lower extremities caused by intertrochanteric fracture falls off, pulmonary embolism will be fatal. At this stage, there are many deep vein thrombosis evaluation scales available in clinical practice, but their application value in patients with intertrochanteric fractures of the femur is not clear.  
OBJECTIVE: To compare the predictive value of five different thrombosis risk assessment scales for lower extremity deep vein thrombosis in patients with intertrochanteric fractures of the femur.
METHODS: The data of 254 patients with intertrochanteric fractures admitted to the Department of Orthopedics, Affiliated Hospital of Southwest Medical University from July 2016 to July 2021 were retrospectively analyzed. According to the examination results of the lower extremity venous ultrasound, the patients were divided into the deep vein thrombosis group and the non-deep vein thrombosis group. Capprini, RAPT, Autar, Pauda and Wells scales were used to evaluate the possible risk of deep vein thrombosis in patients. The scores of five thrombosis risk assessment scales were compared between the two groups. Simultaneously, the receiver operating characteristic curve was drawn and the area under the curve was calculated to analyze the predictive value of five thrombosis risk assessment scales for lower extremity deep vein thrombosis in patients with intertrochanteric fracture.  
RESULTS AND CONCLUSION: (1) The Wells score, Autar score and RAPT score in the deep vein thrombosis group were significantly higher than those in the non-deep vein thrombosis group (P < 0.05). (2) The areas under the curve of Wells, Capprini, RAPT, Autar and Pauda were 0.916, 0.751, 0.767, 0.544 and 0.575, respectively. (3) The sensitivities of Wells, Capprini, RAPT, Autar and Pauda in the diagnosis of deep vein thrombosis in patients with intertrochanteric fracture were 93.22%, 77.97%, 74.01%, 58.76% and 36.16%, respectively. The specificities were 64.94%, 59.74%, 35.06%, 49.35% and 74.03%, respectively. (4) All the above five thrombosis risk assessment scales have certain predictive values for the occurrence of deep vein thrombosis in the lower extremity of hospitalized patients with intertrochanteric fracture, but the Wells risk assessment scale has a relatively high predictive value, followed by Capprini and RAPT assessment scale. The risk assessment value of Wells scale is relatively accurate for whether the patients with intertrochanteric fracture have thrombus. The RAPT scale is applicable to the risk assessment of possible thrombosis in all orthopedic trauma patients.

Key words: deep venous thrombosis, intertrochanteric fracture of femur, rating scale, predictive value, receiver operating characteristic curve, risk assessment

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