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

English Keywords:Spinal cord injury  Deep venous thrombosis  Risk factors  ASIA classification  Fibrinogen

English Abstract:

  【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.