老年患者腰椎融合术后下肢深静脉血栓形成的影响因素

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Influencing factors of lower extremity deep venous thrombosis afterlumbar fusion in elderly patients

Chen Jing，Zhuge Hengyan，Huang Zhihui，Wu Lin

DepartmentofOrthopedics，9O4thHospitalof theChinesePeople'sLiberationArmyJointSupportForce，Wuxi 214000 **Correspondingauthor：WuLin，email：13915223774@63.com

[Abstract]ObjectiveToanalyze the influencing factorsoflower extremitydep venous thrombosis（LEDVT）afterumbar fusionnelderlypatients，andtoexplorethepredictiveValueofperipheralblodmoncytetohigh-densitylipoproteincholestrolatio （MHR）andthrombomodulin（TM）levelsforLEDVT.MethodsNinety-eightelderly patientswhounderwent lumbarfusionatthe 904th HospitaloftheChinesePeople'sLiberationArmyJointSupportForcefromJulyO21toJuly2024wereretrospectivelyselected anddividedintotheoccurrencegroup（23cases）andthe non-occurence group（75cases）according towhetherLEDVToccurred within14daftersurgeryAllpatientsunderwentMHRandTMexaminationbeforeoperation，andtherelevantdata werecollectedfor comparison.MultivariateLogisticregresionmodelwasusedtoanalyzetheifuencingfactorsofpostoperativeLEDV.ROCurvewas usedto analyzethe predictivevalueof MHRandTMforpostoperativeLEDVTinpatients.ResultsThe proportionofpatintsaged ⩾ 75years，smoking，diabetes，D-dimer（D-D）level，postoperativebed-rest ime≥5d，MHRlevel，ndTMlevelintheocuence group were higher than those in the non-occurrence group （ P<0.05 ）．Multivariate logistic regression model results showed that age （ OR=3.612 95%CI ：1.273-10.247），postoperative bed-rest time（ OR=2.553 ， 95%CI ：1.248-5.221），D-Dlevel（ OR= 3.849，95%CI：2.092-7.080），MHRlevel（ OR=2.374 ， 95%CI ：1.452-3.883）andTMlevel（ OR=5.262 95%CI ： 2.324- 11.915）were independent risk factors for postoperative LEDVT（ P<0.05 ）.The ROC curve showed that the sensitivity of MHR，TM and their combination to predict the occurrence of LEDVT in patients was 69.60% ，78. 30% and 91.30%，respectively，and the specificitywas 74.70% ， 68.00% and 65.30% ，respectively，and the area under the curve（AUC）wereO.773，0.796 and O.89O，respectively （ ⋅P<0.05 ）.ConclusionMHR and TMare independent risk factors for postoperative LEDVT in elderly patients treated with lumbarfusion，andcombinedclinical tests havehighersensitivitybutlowerspecificityinassssngtheriskofLEDVTinpatints.

[Key words] Lumbar vertebra；Thrombomodulin；Monocyte；High-density lipoprotein cholesterol；Deep venous thrombo sis：Predictive value

腰椎退行性疾病（Lumbardegenerativedisease，LDD）是临床较为常见的脊柱问题，影响腰椎功能，常因年龄增加、机体腰椎及关节功能发生退行性改变导致，包括腰椎滑脱、不稳、腰椎管狭窄、腰椎间盘突出症等[1-2]。（剩余9958字）