| 凝血纤溶指标联合检测对老年股骨转子间骨折股骨近端防旋髓内钉术后深静脉血栓形成的预测价值 |
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投稿时间：2024-03-03
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| 作者 | Author | 单位 | Address | E-Mail |
| 张宏峰 |
ZHANG Hong-feng |
天水市第一人民医院骨二科, 甘肃 天水 741000 |
Department of Orthopeadics, the First People's Hospital of Tianshui, Tianshui 741000, Gansu, China |
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| 何安吉 |
HE An-ji |
天水市第一人民医院骨二科, 甘肃 天水 741000 |
Department of Orthopeadics, the First People's Hospital of Tianshui, Tianshui 741000, Gansu, China |
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| 赵溪林 |
ZHAO Xi-lin |
天水市第一人民医院骨二科, 甘肃 天水 741000 |
Department of Orthopeadics, the First People's Hospital of Tianshui, Tianshui 741000, Gansu, China |
408085633@qq.com |
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| 期刊信息：《中国骨伤》2025年，第38卷，第4期，第371-377页 |
| DOI：10.12200/j.issn.1003-0034.20231098 |
| 基金项目: |
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中文摘要:
目的: 探讨凝血纤溶指标联合检测对老年股骨转子间骨折患者股骨近端防旋髓内钉(proximal femoralanti-rotation intramedullary nail,PFNA)术后深静脉血栓(deep venous thrombosis,DVT)形成的预测价值。
方法: 采用回顾性病例对照研究分析2019年4月至2023年4月收治的80例行PFNA治疗的老年股骨转子间骨折患者临床资料,其中男26例,女54例;年龄60~85(76.4±5.6)岁。根据PFNA术后是否发生DVT,将其分为DVT组29例,男10例,女19例;年龄(76.9±6.1)岁;非DVT组51例,男16例,女35例,年龄(75.3±6.9)岁。比较PFNA术后即刻、3、7 d两组凝血酶原时间(prothrombin time,PT)、活化部分凝血酶原时间(activated partial prothrombin time,APTT)、凝血酶时间(thrombin time,TT)及血浆纤维蛋白原(fibrinogen,FIB)、血浆凝血酶-抗凝血酶Ⅲ复合物(thrombin-antithrombin,TAT)、D-二聚体水平。采用Pearson相关分析DVT组血浆FIB、TAT、D-二聚体两两之间的相关性。采用多因素Logistic回归分析老年PFNA术后各凝血纤溶指标与DVT的相关性。采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)分析PT、APTT、TT、FIB、TAT、D-二聚体对PFNA术后发生DVT的预测价值。
结果: 两组术后即刻、3 d、7 d的PT、APTT、TT差异均无统计学意义(P>0.05)。DVT组术后即刻、3 d、7 d的血浆FIB分别为(4.68±1.77)、(6.73±2.02)、(8.81±2.86) g·L-1,TAT分别为(10.64±2.30)、(12.88±3.45)、(14.96±4.87)μg·L-1,D-二聚体分别为(635.00±100.88)、(720.02±168.09)、(810.47±170.19)μg·L-1,水平均高于非DVT组的血浆FIB (3.46±0.47)、(3.55±0.52)、(3.67±0.48) g·L-1,TAT (8.58±3.37)、(8.69±3.48)、(8.80±3.50) g·L-1,D-二聚体(588.36±96.68)、(589.58±96.45)、(591.11±95.50) g·L-1,差异有统计学意义(P<0.05)。Pearson相关分析显示,FIB与D-二聚体呈正相关(r=0.428,0.523,P<0.05);FIB与TAT呈正相关(r=0.517,0.411,P<0.05);TAT与D-二聚体呈正相关(r=0.602,0.596,P<0.05)。多因素Logistic回归分析显示,FIB[OR=3.252,95% CI (0.640,3.975),P<0.01]、TAT[OR=1.461,95% CI (1.059,2.011),P<0.05]、D-二聚体[OR=3.830,95% CI (2.032,7.213),P<0.01]与PFNA术后发生DVT显著相关。PT、APTT、TT、FIB、TAT、D-二聚体联合检测对PFNA术后发生DVT的预测价值明显优于各指标单项检测(P<0.01)。
结论: PT、APTT、TT、FIB、TAT、D-二聚体联合检测对老年股骨转子间骨折患者PFNA术后发生DVT有较高的预测价值,有助于早期诊断DVT,早期预防肺栓塞等严重并发症的进一步发生。 |
| 【关键词】髋骨折 静脉血栓形成 股骨近端防旋髓内钉 预测价值 |
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| Predictive value of combined examination of coagulation and fibrinolysis indexes for deep venous thrombosis after proximal femoral nail anti rotation in elderly patients with femoral intertrochanteric fracture |
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ABSTRACT
Objective To investigate the prognostic significance of combined coagulation and fibrinolysis marker analysis in predicting the development of deep venous thrombosis (DVT) following proximal femoral anti rotation intramedullary nail (PFNA) surgery in elderly patients with intertrochanteric femur fractures.
Methods A retrospective analysis was conducted on the clinical data of 80 elderly patients who underwent PFNA treatment for intertrochanteric fractures between April 2019 and April 2023. There were 26 males and 54 females. The patients' ages ranged from 60 to 85 years old,with a mean age of (76.4±5.6) years old. According to the occurrence of DVT following PFNA,patients were categorized into two groups. The DVT group were 29 patients,comprising 10 males and 19 females with a mean age of (76.9 ±6.1)years old. And the non-DVT group were 51 patients,consisting of 16 males and 35 females with a mean age of (75.3 ±6.9)years old. The prothrombin time (PT),activated partial thromboplastin time(APTT),thrombin time(TT),plasma fibrinogen (FIB),plasma thrombin antithrombin complex (TAT),and D dimer levels were compared between the two groups immediately postPFNA surgery,as well as at 3 and 7 days postoperatively. Pearson correlation analysis was conducted to evaluate the relationship between plasma FIB,TAT,and D dimer levels in patients who developed DVT. Multivariate logistic regression analysis was employed to assess the association between each coagulation and fibrinolysis index following PFNA surgery in elderly patients and the incidence of DVT. The area under the receiver operating characteristic (ROC) curve (AUC) was utilized to determine the predictive value of PT,APTT, TT,FIB,TAT,and D-dimer for postoperative DVT occurrence.
Results There were no statistically significant differences in PT,APTT,and TT between the two groups immediately post surgery,at 3 days,and at 7 days (P>0.05). At immediately,3 days and 7 days postoperatively in DVT group,FIB were (4.68±1.77),(6.73±2.02),(8.81±2.86) g·L-1,TAT were (10.64±2.30), (12.88±3.45),(14.96±4.87) μg·L-1 respectively. D dimer were (635.00±100.88),(720.02±168.09),(810.47±170.19) μg· L-1,respectively.In the DVT group FIB were (3.46±0.47),(3.55±0.52),(3.67±0.48) g·L-1,TAT were (8.58±3.37),(8.69±3.48),(8.80±3.50) g·L-1,D dimer were (588.36±96.68),(589.58±96.45),(591.11±95.50) g·L-1. The difference between the two groups was statistically significant (P<0.05). Pearson correlation analysis revealed significant positive correlations between FIB and D dimer (r=0.428,0.523,P <0.05),FIB and TAT (r=0.517,0.411,P <0.05),as well as TAT and D dimer (r=0.602,0.596,P<0.05). Multivariate Logistic regression analysis revealed that FIB OR=3.252,95% CI(0.640,3.975),P<0.01, TAT OR=1.461,95% CI(1.059,2.011),P<0.05,and D dimer OR=3.830,95%CI (2.032 to 7.213),P<0.01 were significantly associated with the development of DVT following PFNA surgery. The combined detection of PT,APTT,TT,FIB,TAT,and D dimer demonstrates significantly greater predictive value for the occurrence of DVT following PFNA surgery compared to individual index detection (P<0.01).
Conclusion The combined detection of PT,APTT,TT,FIB,TAT and D-D has a high predictive value for DVT in elderly patients with femoral intertrochanteric fracture after PFNA,which is of vital importance in the early diagnosis of DVT and early prevention of pulmonary embolism and other serious complications. |
| KEY WORDS Hip fractures Venous Thrombosis Proximal femoral anti rotation Predictive value |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张宏峰,何安吉,赵溪林.凝血纤溶指标联合检测对老年股骨转子间骨折股骨近端防旋髓内钉术后深静脉血栓形成的预测价值[J].中国骨伤,2025,38(4):371~377 |
| 英文格式: | ZHANG Hong-feng,HE An-ji,ZHAO Xi-lin.Predictive value of combined examination of coagulation and fibrinolysis indexes for deep venous thrombosis after proximal femoral nail anti rotation in elderly patients with femoral intertrochanteric fracture[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(4):371~377 |
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