颈椎骨折截瘫患者术后下肢深静脉血栓形成的因素分析及时间分布OA

Objective To investigate the risk factors and tempral distribution of lower extremity deep vein thrombosis(DVT)formation after surgery in patients with cervical spine fracture and paraplegia.Methods A total of 98 patients with cer-vical fracture and paraplegia admitted between January 2020 and January 2023 were enrolled in this study,including 50 males and 48 females.The age ranged from 18 to 80 years with a mean of(63.39±7.26)years,and the body mass index(BMI)ranged from 22.35 to 28.17 with a mean of(24.64±1.71)kg·m-2.Patients were divided into a DVT group(n=22)and a non-DVT group(n=76)based on the occurrence of postoperative DVT.General clinical data were compared between the two groups.The tempral distribution of DVT occurrence was analyzed in DVT patients at preoperation and on postoperative days 1,3,7,and 14,along with management strategies for different types of thrombus formation.Logistic regression analysis was performed to identify independent risk factors associated with postoperative DVT in patients with cervical fracture and paraple-gia.A nomogram model was then constructed based on these identified independent predictors to estimate the risk of postoper-ative DVT in this patient population.Results Among the 98 patients who underwent surgical treatment for cervical fractures,22 developed DVT,yielding an incidence rate of 22.45％(22/98).The peak onset of DVT occurred on the first postoperative day.The number of DVT cases detected preoperatively and on postoperative days 1,3,7,and 14 were 0,16,1,1,and 4,respective-ly.BMI ≥25 kg·m-2,comorbid hypertension,elevated hemoglobin levels,high hematocrit,and the presence of large vascular atherosclerotic plaques were identified as independent risk factors for postoperative DVT in patients with cervical fracture and paraplegia(P＜0.05).A nomogram model was constructed based on these indicators.Internal validation using Bootstrap resam-pling(1 000 replications)demonstrated that the model yielded an area under the curve(AUC)of 0.928,95％CI(0.829,0.990),with a specificity of 0.942 and a sensitivity of 0.872 for predicting postoperative DVT.Conclusion Postopera-tive day 1 is the peak time for DVT occurrence.It is recommended that thromboprophylaxis measures be implemented as early as during or immediately after surgery.BMI,hypertension,hemoglobin,hematocrit,and atherosclerotic plaques in major vessels are independent risk factors for postoperative DVT.The nomogram constructed based on these factors can effectively predict the occurrence of postoperative DVT in patients with cervical spine fractures and paraplegia.