彩色多普勒诊断急性闭合性跟腱断裂合并下肢深静脉血栓的临床价值

摘要

目的 研究急性闭合性跟腱断裂病人下肢深静脉血栓(DVT)的发生及相关情况.方法 连续收集2014年1月-2016年8月我院收治的急性闭合性跟腱断裂病人214例,其中男188例,女26例,年龄19～74岁,平均(38.7±11.3)岁.根据Kuwade分型将跟腱断裂分为Ⅰ、Ⅱ、Ⅲ、Ⅳ型.采用彩色多普勒超声检查作为下肢DVT的诊断标准,分析各型跟腱断裂病人下肢DVT的发生率、血栓检出时间,以及血栓范围分布情况.分别采用卡方检验和秩和检验比较不同跟腱断裂分型的血栓发生率和血栓检出时间.结果 本组病人DVT总发生率为10.7％,其中周围型(血栓累及腘静脉以下)DVT 22例,混合型(血栓累及全下肢深静脉)DVT l例.不同跟腱断裂分型间血栓发生率差异无统计学意义(P＞0.05).不同跟腱断裂分型间血栓检出时间差异有统计学意义(P＜0.05),Ⅰ+Ⅱ型跟腱断裂血栓检出时间最长,Ⅲ型次之,Ⅳ型检出时间最短.结论 急性闭合性跟腱断裂病人DVT相关检查不可忽视,及早发现及早采取预防措施可避免发展成为致命的中央型血栓.彩色多普勒超声可作为跟腱断裂后下肢DVT的首选检查方法.%Objective To investigate the incidence and related factors of deep venous thrombosis (DVT) in patients with acute closed Achilles tendon rupture.Methods A total of 214 patients with acute closed Achilles tendon rupture in our hospital from January 2014 to August 2016 were collected.There were 188 males and 26 females,aged 19-74 years,with an average age of 38.7±11.3 years.According to the Kuwade classification,the rupture of Achilles tendon was divided into Ⅰ,Ⅱ,Ⅲ,and Ⅳ types.Color Doppler ultrasonography was used as the diagnostic criteria for deep venous thrombosis of lower extremities to analyze the incidence of DVT of lower extremity,the time of thrombosis,and the distribution of thrombus.Chisquare test and rank sum test were used to compare the incidence of thrombosis and the time of thrombus detection among different types of Achilles tendon rupture.Results The total incidence rate of DVT was 10.7％,including peripheral DVT (the thrombus involved below the popliteal vein) in 22 cases,and mixed type DVT (the thrombus involved the entire lower extremity vein) in 1 case.There was no significant difference in the incidence of thrombosis among different types of Achilles tendon rupture (P＞0.05).There was a significant difference in the mean time among the different types of Achilles tendon rupture thrombosis (P＜0.05).The detection times of Type Ⅰ and type Ⅱ thrombosis were the longest,followed by the one of type Ⅲ,the detection time of type Ⅳ was the shortest.Conclusion In patients with acute Achilles tendon rupture complicated with deep venous thrombosis,related examination cannot be ignored.Early detection and early preventive measures can avoid the development of a central type of fatal thrombosis.Color Doppler ultrasound can be used as the first choice method for DVT of lower limbs after Achilles tendon rupture.