A comparative study of the treatment methods for patients with bone trauma complicated by deep vein thrombosis of lower limbs
于洪波 1兰浩昌 1林明强 1姜红江 1王飞 1王丽萍
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作者信息
1. 山东省文登整骨医院骨科，威海 264400
折叠
摘要
目的 比较不同治疗方法治疗骨创伤并发下肢深静脉血栓形成（DVT）患者的临床效果。 方法 本研究为回顾性队列研究。回顾性分析2019年1月至2021年12月山东省文登整骨医院骨科收治的367例骨创伤并发DVT患者的临床资料。根据治疗方法分为单纯抗凝组（A组）、抗凝+滤器置入组（B组）、抗凝+滤器置入+导管接触性溶栓组（C组）、抗凝+滤器置入+药物-机械血栓清除组（D组），每组根据随机表法随机抽取30例纳入分析。对比分析各组患者治疗后临床有效率、治疗前后凝血功能指标、治疗后并发症发生率及死亡率情况。 结果 A~D组患者治疗后临床有效率分别为16.7%（5/30）、26.7%（8/30）、96.7%（29/30）及100%（30/30），C组和D组高于A组和B组，差异有统计学意义（均P<0.05）。四组治疗后D-二聚体较治疗前均降低，差异有统计学意义（均P<0.05）。相较于A~C组，D组治疗后D-二聚体和凝血酶原时间较低，差异有统计学意义（均P<0.05）。A~D组治疗后出血发生率分别为6.7%（2/30）、3.3%（1/30）、10.0%（3/30）及3.3%（1/30），肺栓塞（PE）发生率分别为6.7%（2/30）、0、0及0，血栓形成后综合征（PTS）发生率分别为60.0%（18/30）、40.0%（12/30）、3.3%（1/30）及0，死亡率分别为3.3%（1/30）、0、0和0；C组与D组治疗后PTS发生率低于A组和B组，差异有统计学意义（均P<0.05）；出血、PE发生率和死亡率组间比较差异无统计学意义（均P>0.05）。 结论 骨创伤并发DVT患者采用抗凝+滤器置入+药物-机械血栓清除治疗效果更好且安全性更高，能及时清除血栓，恢复血管通畅，具有更低的PTS发生率，改善患者凝血功能，。 Objective To compare the clinical effect of different treatment methods on patients with deep vein thrombosis (DVT) of lower extremity complicated by bone trauma. Methods The clinical data of 367 patients with bone trauma complicated by DVT admitted to the Department of Orthopedics of Wendeng Osteopathic Hospital of Shandong Province from January 2019 to December 2021 were retrospectively analyzed. According to the treatment methods, the patients were divided into simple anticoagulation group (group A), anticoagulation+filter placement group (group B), anticoagulation+filter placement+catheter-directed thrombolysis group (group C), anticoagulation+filter placement+pharmamechanical thrombectomy group (group D), and 30 cases were randomly selected for analysis in each group using random table method. Clinical effective rate, coagulation function index before and after the treatment, incidence of complications and mortality of all groups were compared and analyzed. Results The clinical effective rates of patients in groups A to D after treatment were 16.7% (5/30), 26.7% (8/30), 96.7% (29/30) and 100% (30/30) respectively, and groups C and D were higher than groups A and B with statistically significant differences (all P<0.05). The D-dimer of the four groups after treatment was lower than that before treatment, and the differences were statistically significant (allP<0.05). Compared with groups A to C, group D after treatment demonstrated lower D-dimer and shorter prothrombin time , and the differences were statistically significant (allP<0.05). The incidence of hemorrhage after treatment of groups A to D was 6.7% (2/30), 3.3% (1/30), 10.0% (3/30) and 3.3% (1/30) the incidence of pulmonary embolism (PE) was 6.7% (2/30), 0, 0 and 0 the incidence of post-thrombotic syndrome (PTS) was 60.0% (18/30), 40.0% (12/30), 3.3%(1/30) and 0, and the mortality was 3.3% (1/30), 0, 0 and 0. The incidence of PTS in group C and D after treatment were lower than those in group A and B, and the differences were statistically significant (allP<0.05). The differences of the incidence of hemorrhage, PE and mortality among the four groups were not statistically significant (allP>0.05). Conclusion For patients with bone trauma complicated by DVT, anticoagulation+filter placement+pharmamechanical thrombectomy treatment is safer, which can remove thrombus in time and restore patency of blood vessels. With a lower incidence of PTS, this treatment can improve the coagulation function of patients, promoting early recovery of patients.
Abstract
Objective To compare the clinical effect of different treatment methods on patients with deep vein thrombosis (DVT) of lower extremity complicated by bone trauma. Methods The clinical data of 367 patients with bone trauma complicated by DVT admitted to the Department of Orthopedics of Wendeng Osteopathic Hospital of Shandong Province from January 2019 to December 2021 were retrospectively analyzed. According to the treatment methods, the patients were divided into simple anticoagulation group (group A), anticoagulation+filter placement group (group B), anticoagulation+filter placement+catheter-directed thrombolysis group (group C), anticoagulation+filter placement+pharmamechanical thrombectomy group (group D), and 30 cases were randomly selected for analysis in each group using random table method. Clinical effective rate, coagulation function index before and after the treatment, incidence of complications and mortality of all groups were compared and analyzed. Results The clinical effective rates of patients in groups A to D after treatment were 16.7% (5/30), 26.7% (8/30), 96.7% (29/30) and 100% (30/30) respectively, and groups C and D were higher than groups A and B with statistically significant differences (all P<0.05). The D-dimer of the four groups after treatment was lower than that before treatment, and the differences were statistically significant (allP<0.05). Compared with groups A to C, group D after treatment demonstrated lower D-dimer and shorter prothrombin time , and the differences were statistically significant (allP<0.05). The incidence of hemorrhage after treatment of groups A to D was 6.7% (2/30), 3.3% (1/30), 10.0% (3/30) and 3.3% (1/30) the incidence of pulmonary embolism (PE) was 6.7% (2/30), 0, 0 and 0 the incidence of post-thrombotic syndrome (PTS) was 60.0% (18/30), 40.0% (12/30), 3.3%(1/30) and 0, and the mortality was 3.3% (1/30), 0, 0 and 0. The incidence of PTS in group C and D after treatment were lower than those in group A and B, and the differences were statistically significant (allP<0.05). The differences of the incidence of hemorrhage, PE and mortality among the four groups were not statistically significant (allP>0.05). Conclusion For patients with bone trauma complicated by DVT, anticoagulation+filter placement+pharmamechanical thrombectomy treatment is safer, which can remove thrombus in time and restore patency of blood vessels. With a lower incidence of PTS, this treatment can improve the coagulation function of patients, promoting early recovery of patients.
关键词
骨创伤/深静脉血栓形成/肺栓塞/血栓形成后综合征
Key words
Bone trauma/Deep vein thrombosis/Pulmonary embolism/Thrombosis syndrome
万方数据