老年Neer Ⅲ、Ⅳ型肱骨近端骨折术后下肢深静脉血栓形成的危险因素

doi:10.3969/j.issn.1005-6483.20250420

摘要/Abstract

摘要： 目的探究老年Neer Ⅲ、Ⅳ型肱骨近端骨折术后下肢深静脉血栓（DVT）形成的危险因素，分析BMI分层与抗凝策略的关联性。方法 2022年6月~2024年6月收治的老年Neer Ⅲ、Ⅳ型肱骨近端骨折术后病人200例，依据BMI将病人分为低体重组组（BMI＜18.5kg/m²）、正常组（18.5kg/m²≤BMI＜24.0kg/m²）、超重组（24.0kg/m²≤BMI＜28.0kg/m2）和肥胖组（BMI≥28.0kg/m²）。比较不同组病人一般资料、合并症、手术相关指标、抗凝策略及DVT发生情况。采用多因素Logistic回归分析筛选下肢DVT形成的危险因素，并分析BMI分层与抗凝策略的关联性。〖结果 200例病人中，发生下肢DVT 32例，总发生率为16.0%。不同组病人年龄、合并症（高血压、糖尿病、心血管疾病）、手术时间、住院时间比较，差异有统计学意义（P＜0.05）。多因素Logistic回归分析显示，肥胖（OR=3.25，95%CI:1.56~6.77）、高血压（OR=2.18，95%CI: 1.12~4.24）、手术时间≥2小时（OR=2.36，95%CI :1.21~4.60）以及未规范抗凝（OR=3.87，95%CI: 1.95~7.69）是老年Neer Ⅲ、Ⅳ型肱骨近端骨折术后下肢DVT形成的独立危险因素（P＜0.05）。肥胖组规范抗凝比例最低，与其他组比较差异有统计学意义（P＜0.05）。结论老年Neer Ⅲ、Ⅳ型肱骨近端骨折术后下肢DVT形成受多种因素影响，肥胖是重要危险因素之一。BMI分层与抗凝策略存在关联性，肥胖病人规范抗凝比例较低，临床应根据病人BMI分层制定个体化抗凝策略，以降低下肢DVT发生风险。

关键词: 老年, Neer Ⅲ型肱骨近端骨折, Neer Ⅳ型肱骨近端骨折, 下肢深静脉血栓, BMI分层, 抗凝策略

Abstract: Objective To explore the risk factors for the formation of lower extremity deep vein thrombosis (DVT) after surgery for proximal humeral fractures of Neer type Ⅲ and Ⅳ in the elderly,and to analyze the correlation between BMI stratification and anticoagulation strategies.Methods The clinical data of 200 elderly patients after surgery for proximal humeral fractures of Neer type Ⅲ and Ⅳ admitted from June 2022 to June 2024 were retrospectively analyzed.According to BMI,the patients were divided into a low BMI group (BMI < 18.5kg/m²),a normal BMI group (18.5kg/m² ≤ BMI < 24.0kg/m²),an overweight BMI group (24.0kg/m² ≤ BMI < 28.0kg/m²),and an obese BMI group (BMI ≥ 28.0kg/m²).The general data,comorbidity status,surgery-related indicators,anticoagulation strategies,and DVT occurrence were compared among patients in different BMI groups.Multivariate Logistic regression analysis was used to screen for risk factors for DVT formation and analyze the correlation between BMI stratification and anticoagulation strategies.Results Among the 200 patients,32 cases of DVT occurred,with a total incidence of 16.0%.There were differences in age,comorbidities (hypertension,diabetes,cardiovascular diseases),operation time,and hospital stay among patients in different BMI groups (P<0.05).Multivariate Logistic regression analysis showed that obese BMI (OR=3.25,95%CI:1.56~6.77),hypertension (OR=2.18,95%CI:1.12~4.24),operation time ≥ 2 hours (OR=2.36,95%CI:1.21~4.60),and non-standard anticoagulation (OR=3.87,95%CI:1.95~7.69) were independent risk factors for the formation of DVT after surgery for proximal humeral fractures of Neer type Ⅲ and Ⅳ in the elderly（P＜0.05）.In terms of anticoagulation strategies,the proportion of standardized anticoagulation in the obese BMI group was the lowest,and the difference was statistically significant compared with other groups (P<0.05).Conclusion The formation of DVT after surgery for proximal humeral fractures of Neer type Ⅲ and Ⅳ in the elderly is affected by multiple factors,and obese BMI is one of the important risk factors.There is a correlation between BMI stratification and anticoagulation strategies.The proportion of standardized anticoagulation in obeseBMI patients is low.Clinically,individualized anticoagulation strategies should be developed according to the patient's BMI stratification to reduce the risk of DVT.

Key words: elderly, proximal humeral fractures of Neer type Ⅲ, proximal humeral fractures of Neer type Ⅳ, lower extremity deep vein thrombosis, BMI stratification, anticoagulation strategy

李淼胡晓川王辉辉彭晨曦张艺翊陈杭. 老年Neer Ⅲ、Ⅳ型肱骨近端骨折术后下肢深静脉血栓形成的危险因素[J]. 临床外科杂志, 2026, 34(5): 580-584.

LI Miao, HU Xiaochuan, WANG Huihui, PENG Chenxi, ZHANG Yiyi, CHEN Hang. Risk factors for deep vein thrombosis of the lower extremities after surgery for elderly Neer type Ⅲand Ⅳ proximal humeral fractures[J]. JOURNAL OF CLINICAL SURGERY, 2026, 34(5): 580-584.

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