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《Chinese Journal of Bone and Joint Injury》 2011-12
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Diagnosis and Treatment Strategy for Lower Extremity Fracture Combined with Deep Venous Thrombosis Before Operation

Qiu Haibin,Zhao Xuewen,Liu Yan.Department of Orthopaedics,the First Affiliated Hospital of Tsinghua University,Beijing,100016  
Objective To investigate the diagnosis and treatment strategy for lower extremity fracture combined with DVT before operation.Methods All of 168 patients with lower extremity fracture underwent delayed operation.Before the operation,they received dynamical checks of D-dimer(DD) and lower limbs vascular color Doppler ultrasound(CDU).If the CDU results were negative,DD was less three times as the normal and the result was decreased gradually in the dynamic checks,the DVT could be excluded.If the CDU results were negative,DD was over three times as the normal,and the result was not decreased in the dynamical checks,it could be diagnosed as thrombosis risk state.If the CDU results were positive,DVT could be diagnosed.The patients diagnosed as DVT before operation,with the definite operation indication and well-off,could be operated after inferior vena cava filter(IVCF).The patients diagnosed as DVT before operation,with the condition for delayed operation,and in thrombosis risk state of DD over three times as the normal in the dynamic checks,should be first treated by anticoagulant thrombolysis therapy and dynamic monitoring DD.When DD was lowered to less three times as the normal and CDU confirmed no thrombosist,they could receive the operation.Results Five cases of DVT and 1 case of thrombosis risk state were diagnosed before the operation.Three cases of DVT had operation after IVCF,1 case of DVT and 1 case of thrombosis risk state had delayed operation after the anticoagulant thrombolysis therapy.One case gave up treatment.Conclusion Combination of DD with CDU is an effective method for diagnosing DVT.How to select the further treatment method when DVT occurs before the operation should depend on concrete conditions.
【CateGory Index】: R473.6
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