血栓弹力图和凝血四项在股骨转子间骨折术后下肢深静脉血栓形成中的相关性

Correlation between Thromboelastography and Coagulation Profile in Deep Vein Thrombosis of the Lower Extremity after Intertrochanteric Femoral Fracture Surgery

摘要: 目的：分析血栓弹力图(TEG)和凝血四项各参数在股骨转子间骨折术后患者下肢深静脉血栓形成中的相关性。方法：选择2025年05月至2026年05月本院收治的股骨转子间骨折手术患者162例的临床资料，结合围术期有无出现DVT分成DVT组45例和无DVT组117例，入院第1天(D1)、术后第1天(D2)、术后第7天(D3)行下肢静脉彩色超声检查，统计两组所得参数进行相关性分析。结果：与非DVT组比较，DVT组ACT值、R值、K值降低，α角和MA值升高，差异均有统计学意义(P < 0.05)。Pearson相关性分析显示，TEG中的ACT值与PT值(r = 0.253, P = 0.001)和PTINR值(r = 0.219, P = 0.005)呈正相关，R值与PT值(r = 0.187, P = 0.017)和PTINR值(r = 0.170, P = 0.030)呈正相关，α角与PLT值(r = 0.216, P = 0.006)和FIB值(r = 0.275, P < 0.001)呈正相关，MA值与PLT值(r = 0.212, P = 0.007)呈正相关。ROC曲线分析得出，ACT、R、K、α角、MA预测股骨转子间骨折术后静脉血栓的AUC分别为0.929、0.945、0.985、0.913、0.901，均具有统计学意义(P < 0.05)。结论：血栓弹力图和常规凝血指标在股骨转子间骨折患者术后DVT预测中有着重要价值，存在明显的相关性，在评估股骨转子间骨折手术患者围手术期凝血状态中，可考虑使用TEG及凝血指标，给临床制定有关防治措施提供参考依据。

Abstract: Objective: To analyze the correlation between parameters of thromboelastography (TEG) and conventional coagulation tests in patients with deep vein thrombosis (DVT) following surgery for intertrochanteric femoral fractures. Methods: Clinical data from 162 patients who underwent surgery for intertrochanteric femoral fractures at our hospital between May 2025 and May 2026 were collected. Patients were divided into a DVT group (n = 45) and a non-DVT group (n = 117) based on whether DVT occurred during the perioperative period. Lower limb venous color Doppler ultrasound was performed on day 1 of admission (D1), postoperative day 1 (D2), and postoperative day 7 (D3). The obtained parameters from both groups were analyzed for correlations. Results: Compared to the non-DVT group, the DVT group showed significantly lower ACT, R, and K values, and higher α angle and MA values (P < 0.05). Pearson correlation analysis revealed that TEG ACT correlated positively with PT (r = 0.253, P = 0.001) and PTINR (r = 0.219, P = 0.005); R value correlated positively with PT (r = 0.187, P = 0.017) and PTINR (r = 0.170, P = 0.030); α angle correlated positively with PLT (r = 0.216, P = 0.006) and FIB (r = 0.275, P < 0.001); and MA correlated positively with PLT (r = 0.212, P = 0.007). ROC curve analysis showed that the AUCs for predicting postoperative venous thrombosis using ACT, R, K, α angle, and MA were 0.929, 0.945, 0.985, 0.913, and 0.901, respectively, all of which were statistically significant (P < 0.05). Conclusion: Thromboelastography and conventional coagulation parameters have significant value in predicting postoperative DVT in patients with intertrochanteric femoral fractures and show clear correlations. These indicators may be considered in assessing the coagulation status of patients undergoing intertrochanteric femoral fracture surgery, providing valuable reference for clinical prevention and treatment strategies.