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.

参考文献

相关文章 15

[1]	黄玮，邓文强，王鹏涛，刘丽，西尔艾力·麦麦提. 基于经胸超声的容量与心功能评估在急诊手术及老年病人麻醉管理中的应用价值[J]. 临床外科杂志, 2026, 34(6): 706-710.
[2]	薛清泉，冯桂林，梁双超，夏友传，李方宽. 数字减影血管造影结合Acostream血栓抽吸系统在急性下肢深静脉血栓形成中的应用[J]. 临床外科杂志, 2026, 34(6): 711-714.
[3]	陈佳欣李文李玉倩原雨梦安美霞. 基于POSSUM系统、炎性因子对老年局部晚期食管鳞癌病人术后严重并发症的预测模型的构建与验证[J]. 临床外科杂志, 2026, 34(2): 139-144.
[4]	喻先军, 胡蓉, 李晓娅, 赵思淳, 汪竹, 张定伟. 中性粒细胞胞外陷阱在老年髋部骨折病人术后肺炎的预测价值研究[J]. 临床外科杂志, 2026, 34(1): 86-89.
[5]	马连港陈志雷陆丹莹李琳朱静萱马华崇王振军渠浩. 老年结直肠癌病人腹腔镜手术后延迟性肠麻痹的危险因素分析[J]. 临床外科杂志, 2025, 33(8): 808-812.
[6]	刘耀华侯秀秀赵玲王赛魏娜张文宝. 老年股骨粗隆间骨折髓内钉内固定术后3年病情转归的预测模型构建与检验[J]. 临床外科杂志, 2025, 33(8): 870-874.
[7]	侯自明刘东远杨俊侯哲王浩张洪兵. 高流量湿化氧疗联合气管切开在老年脑出血病人中的应用效果及肺部感染的危险因素分析[J]. 临床外科杂志, 2025, 33(7): 697-.
[8]	李强唐琳李兴龚敏. 老年胆总管结石内镜逆行胰胆管造影术术后并发胰腺炎的临床指标变化及危险因素分析[J]. 临床外科杂志, 2025, 33(6): 619-622.
[9]	王怡凤华荣何毅. 老年食管癌病人术后并发症Clavien-Dindo分级≥Ⅲ级的影响因素及列线图预测模型构建[J]. 临床外科杂志, 2025, 33(3): 261-266.
[10]	胡吉查本俊黄凤英张海华. 每搏量变异度指导目标导向输液在老年腰椎手术中的应用研究[J]. 临床外科杂志, 2025, 33(2): 196-199.
[11]	夏冰清夏小军王蓉葛一凡张文婷. 呼吸引导踝泵运动联合低分子肝素皮下注射在肝门胆管癌根治术后下肢深静脉血栓预防中的作用[J]. 临床外科杂志, 2025, 33(12): 1299-1302.
[12]	余儒意夏冬刘涛. D-二聚体/血小板计数比值对结肠癌根治术后下肢深静脉血栓的预测价值[J]. 临床外科杂志, 2025, 33(11): 1194-1197.
[13]	何长怀叶品张学成李毅清蔡传奇. 预测AngioJet机械血栓抽吸技术的清除效率：新型列线图的构建[J]. 临床外科杂志, 2024, 32(9): 970-974.
[14]	梁学刚王祥金张全刚. 导管溶栓联合髂静脉球囊扩张对急性下肢深静脉血栓合并Cockett综合征并发症及凝血功能的影响[J]. 临床外科杂志, 2024, 32(9): 980-984.
[15]	刘静王慧文. 近十年国内外老年骨折病人营养相关研究的文献计量学分析[J]. 临床外科杂志, 2024, 32(8): 858-862.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed