Incidence and risk factors of deep vein thrombosis during waiting period before operation for calcaneal fractures by ultrasound elastography

doi:10.3969/j.issn.2095-4344.2017.03.018

Abstract

Abstract:

BACKGROUND: Deep vein thrombosis occurred during waiting period before operation affects the prognosis of calcaneal fractures. Therefore, it has important clinical significance for its accurate diagnosis. The staging of thrombosis during waiting period before operation for calcaneal fractures is rarely reported.

OBJECTIVE: To detect the incidence and risk factors of deep vein thrombosis in patients with calcaneal fracture by ultrasound elastography imaging after staging diagnosis of thrombosis.

METHODS: All objects were included in the study from patients with calcaneal fractures waiting for surgery in the Qinghai University Affiliated Hospital between 2008 and 2015. Patients received preoperative duplex ultrasonography. Those with thrombosis received ultrasound elastography. The incidence of thrombosis was calculated. According to medical records, age, sex, body mass index and history of smoking were collected. The correlation between thrombosis and above factors was analyzed by multiple Logistic regression analysis.

RESULTS AND CONCLUSION: (1) One hundred and forty-nine patients were finally included. Of these, 22 (14.8%) were found to affect deep vein thrombosis in the lower limb. The incidence of acute thrombosis was 9.4%. (2) Multiple Logistic regression analysis suggested that age (P=0.009, OR=1.063, 95% confidence interval (CI) 1.010–1.117), body mass index (P=0.019, OR=1.302, 95% CI 1.124–1.430), history of smoking (P=0.017, OR=5.124, 95% CI 1.347-18.359), and operation waiting time (P=0.000, OR=5.190, 95% CI 1.396–19.266) were risk factors of acute lower extremity deep venous thrombosis. (3) These results suggest that the incidences of preoperative deep vein thrombosis and acute deep vein thrombosis are very high. The risk assessment of acute deep vein thrombosis should be taken according to the patient’s age, smoking history, body mass index, as well as the time waiting for surgery. The corresponding diagnosis and treatment program should be given to patients with thrombosis.

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

Key words: Calcaneus, Fractures, Bone, Venous Thrombosis, Ultrasonography, Doppler, Tissue Engineering

CLC Number:

R318

Lu Zhong-lin, Cao Zhi-qiang, Gao Guo-liang, Jing Qing-ling, Zhang Wei, Huang Yong. Incidence and risk factors of deep vein thrombosis during waiting period before operation for calcaneal fractures by ultrasound elastography[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(3): 423-427.

Figures/Tables 2

References

[1] Zhang X, Liu Y, Peng A, et al. Clinical efficacy and prognosis factors of open calcaneal fracture: a retrospective study. Int J Clin Exp Med. 2015;8(3):3841-3847.

[2] Pang QJ, Yu X, Guo ZH. The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture: A finite element analysis. Pak J Med Sci. 2014;30(5):1099-1103.

[3] Zhang QS, Zhang SH, University SM. Comparison and Analysis of Two Surgical Methods in Treatment of Sanders Ⅱ、Ⅲ Type Calcaneal Fracture. Journal of Clinical Microbiology. 2015; 53(4):462-470.

[4] Inagawa T, Hamagishi T, Takaso Y, et al. Decreased activity of daily living produced by the combination of Alzheimer's disease and lower limb fracture in elderly requiring nursing care. Environ Health Prev Med. 2013;18(1):16-23.

[5] Pitto RP, Young S. Foot-pumps without graduated compression stockings for prevention of deep-vein thrombosis in total joint replacement: efficacy, safety and patient compliance : A comparative, prospective clinical trial. Int Orthop. 2008;32(3):337.

[6] 李晓东,安可英,孙国锋,等.低分子肝素预防老年髋关节周围骨折围术期下肢深静脉血栓的研究[J].重庆医学,2013,42(25): 2964-2965,2968.

[7] Bates SM, Jaeschke R, Stevens SM, et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl): e351S-418S.

[8] Kassaï B, Sonié S, Shah NR, et al. Literature search parameters marginally improved the pooled estimate accuracy for ultrasound in detecting deep venous thrombosis. J Clin Epidemiol. 2006;59(7):710-714.

[9] Lin F, Hazard CR, Seyed-Bolorforosh M, et al. Apparatus, System, and Method for Adaptively Controlling a Frame Interval Between Ultrasound Scanning Frames for AN Ultrasound Elasticity Imaging Scan. Journal of the Acoustical Society of America. 2012; 132(3):1876.

[10] Fraquelli M, Branchi F, Cribiù FM, et al. Tu1217 Ultrasound Elasticity Imaging Accurately Quantifies Ileal Fibrosis in Patients With Crohn's Disease. Gastroenterology. 2015; 148(4):S825.

[11] Forsberg A, Söderberg S, Engström Å. People's experiences of suffering a lower limb fracture and undergoing surgery. J Clin Nurs. 2014n;23(1-2):191-200.

[12] Niikura T, Sakai Y, Lee SY, et al. Rate of venous thromboembolism after complex lower-limb fracture surgery without pharmacological prophylaxis. J Orthop Surg (Hong Kong). 2015;23(1):37-40.

[13] Long A, Zhang L, Zhang Y, et al. Efficacy and safety of rivaroxaban versus low-molecular-weight heparin therapy in patients with lower limb fractures. J Thromb Thrombolysis. 2014;38(3):299-305.

[14] 王瑜. 彩色多普勒超声诊断下肢深静脉血栓的应用价值分析[J]. 中国实验诊断学, 2014,18(6):1017-1018.

[15] Sousa Nanji L, Torres Cardoso A, Costa J, et al. Analysis of the Cochrane Review: thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev. 2014,1: CD002783. Acta Med Port. 2015;28(1):12-14.

[16] 韦溦,杨星华,官正华,等.上肢创伤骨折围手术期并发深静脉血栓的诊治体会[J].局解手术学杂志,2014,23(3):268-269.

[17] 罗文东,张毅,赵刚.下肢骨折术后深静脉栓塞防治进展[J].医学综述,2014,20(23):4326-4327.

[18] Goel MS, Diamond SL. Adhesion of normal erythrocytes at depressed venous shear rates to activated neutrophils, activated platelets, and fibrin polymerized from plasma. Blood. 2002;100(10):3797-3803.

[19] Solis G, Saxby T. Incidence of DVT following surgery of the foot and ankle. Foot Ankle Int. 2002;23(5):411-414.

[20] 董玉金,张铁慧,钟声,等.创伤骨折患者深静脉血栓形成的危险因素分析[J].中华骨科杂志,2015,35(11):1077-1083.

[21] Williams JR, Little MT, Kramer PA, et al. Incidence of Preoperative Deep Vein Thrombosis in Calcaneal Fractures. J Orthop Trauma. 2016;30(7):e242-245.

[22] Lin CH, Chen WL, Du CH, et al. Prevention of deep vein thrombosis and pulmonary embolism. Anaesthesia & Intensive Care Medicine. 2015;16(9):1330-1334.

[23] 臧加成,马信龙,马剑雄,等.不同部位骨折深静脉血栓发生率的流行病学研究[J].中华骨科杂志,2016,36(9):540-545.

[24] Björgell O, Nilsson PE, Nilsson JA, et al. Location and extent of deep vein thrombosis in patients with and without FV:R 506Q mutation.Thromb Haemost. 2000;83(5):648-651.

[25] Protty MB, Aithal S, Hickey B, et al. Mechanical prophylaxis after hip fracture: what is the risk of deep vein thrombosis? A retrospective observational study. BMJ Open. 2015;5(2): e006956..

[26] 刘海波,赵枫,曹杰,等.髋臼及骨盆骨折患者术前深静脉血栓形成的危险因素[J].河北医学,2016,22(8):1246-1249.