胸腰段脊柱骨折合并急性创伤性脊髓损伤患者术后深静脉血栓的危险因素分析

Risk factors of deep venous thrombosis in patients with thoracolumbar spinal fracture complicated with acute traumatic spinal cord injury

中文关键词:  脊髓损伤  深静脉血栓  危险因素  ASIA分级  血浆纤维蛋白原

英文关键词:Spinal cord injury  Deep venous thrombosis  Risk factors  ASIA classification  Fibrinogen

中文摘要:

  【摘要】 目的：探讨胸腰段脊柱骨折合并急性创伤性脊髓损伤患者术后深静脉血栓的危险因素。方法：选取2018年7月~2020年9月于我院进行手术治疗的T11～L2骨折合并急性创伤性脊髓损伤（spinal cord injury，SCI）患者136例。收集患者的统计患者的年龄、性别、体重指数、既往病史等一般资料，检测并收集患者总胆固醇（total cholesterol，TC）、甘油三酯（triacylglycerol，TG）、低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL-C）、高密度脂蛋白（high density lipoprotein cholesterol, HDL-C）等实验室指标。收集患者术前、术后6个月内的下肢静脉彩超，根据是否出现DVT分为DVT组（n=64）和非DVT组（n=72）。比较两组患者的一般资料，通过单因素分析及多因素Logistic回归分析确定急性创伤性SCI患者术后发生DVT的独立影响因素。通过Spearman法和Pearson法分析各影响因素间的相关性。根据独立影响因素建立并验证列线图模型。结果：单因素分析结果显示，DVT组和非DVT组的体重指数（27.03±2.12kg/m2和24.03±3.32kg/m2）、吸烟人数占比（39.06%和20.83%）、输血人数占比（45.31%和27.78%）、肿瘤病史人数占比（46.89%和23.61%）、出血量＞600 mL人数占比（42.19%和22.22%）、ASIA分级A级人数占比（45.31%和18.06%）、肢体气压治疗及踝泵练习人数占比（18.75%和52.78%）、ASIA分级D级人数占比（14.06%和33.33%）、CRP（20.36±4.37和11.45±3.76）、FIB（6.49±1.31和4.51±1.26）以及D-二聚体（1.83±0.39和0.45±0.26）之间的差异均具有统计学意义（P＜0.05）。多因素Logistic回归分析显示，输血、ASIA分级A级、FIB>5g/L、D-二聚体>1.6mg/L以及未进行肢体气压治疗及踝泵练习是急性创伤性SCI患者术后DVT的独立危险因素（P＜0.05），相关性分析显示，输血、ASIA分级A级、FIB、D-二聚体以及未进行肢体气压治疗及踝泵练习均呈明显的正相关关系（P＜0.05）。根据独立影响因素构建列线图预测模型，模型的ROC曲线下面积（area under curve，AUC）为0.837（95%CI：0.791~0.864），具有较好的区分度，校准曲线评价结果提示模型具有较好的准确性。结论：输血、ASIA分级A级、FIB>5g/L、D-二聚体>1.6mg/L以及未进行肢体气压治疗及踝泵练习是急性创伤性SCI患者术后DVT形成的独立危险因素，各独立危险因素之间均存在密切联系。

英文摘要:

  【Abstract】 Objectives: To explore the risk factors of deep venous thrombosis(DVT) in patients with thoracolumbar spinal fracture complicated with acute traumatic spinal cord injury. Methods: 136 patients with T11-L2 fracture complicated with acute traumatic spinal cord injury(SCI) who underwent surgical treatment in our hospital from July 2018 to September 2020 were selected. The age, sex, body mass index, past medical history and other general data of the patients were collected. The total cholesterol(TC), triacylglycerol(TG), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C) and other laboratory indicators were detected and collected. The color Doppler ultrasound of the lower limb veins of the patients before surgery and within 6 months after surgery were collected. The patients were divided into DVT group(n=64) and non-DVT group(n=72) according to whether occurred DVT or not. The general data of the two groups were compared, and the independent influencing factors of DVT in patients with acute traumatic SCI were determined by univariate analysis and multivariate Logistic regression analysis. The correlation between the influencing factors was analyzed by Spearman method and Pearson method. The nomograph model was established according to the independent influencing factors, and the model was verified. Results: Univariate analysis showed that there were statistical differences between DVT group and non-DVT group in the body mass index(BMI)(27.03±2.12kg/m2 vs 24.03±3.32kg/m2), the proportion of smokers(39.06% vs 20.83%), the patient proportion of blood transfusions(45.31% vs 27.78%), the patient proportion with tumor history(46.89% vs 23.61%), the patient proportion with bleeding volume>600ml(42.19% and 22.22%), the patient proportion of ASIA grade A(45.31% vs 18.06%), the patient proportion of limb barotherapy and ankle pump exercise(18.75% vs 52.78%), patient proportion of ASIA grade D(14.06% vs 33.33%), CRP(20.36±4.37 vs 11.45±3.76), FIB(6.49±1.31 vs 4.51±1.26), and D-Dimer(1.83±0.39 vs 0.45±0.26)(P<0.05). Multivariate logistic regression analysis showed that blood transfusion, ASIA grade A, FIB>5g/L, D-dimer>1.6mg/L, and no limb barotherapy or ankle pump exercise were independent risk factors for DVT formation in patients with acute traumatic SCI(P<0.05). Correlation analysis showed that blood transfusion, ASIA grade A, FIB, D-dimer, no limb barotherapy and ankle pump exercise were significantly positively correlated(P<0.05). The nomogram prediction model was constructed according to independent influencing factors. The area under curve(AUC) of the model was 0.837(95%CI: 0.791-0.864), which had good discrimination. The evaluation results of the calibration curve suggested that the model had good accuracy. Conclusions: Blood transfusion, ASIA grade A, FIB>5g/L, D-dimer>1.6mg/L, and no limb barotherapy and ankle pump exercise are independent risk factors for DVT formation in patients with acute traumatic SCI. There was a close relationship between the independent risk factors.