Objective:To investigate the effect of intraoperative blood transfusion on postoperative deep vein thrombosis in patients with orthopedic trauma.Methods:A retrospective analysis was conducted of the 502 patients who had been treated operatively at Department of Orthopaedics and Trauma, Xi＇an Honghui Hospital from January 2015 to September 2018. They were divided into 2 groups according to the use of intraoperative blood transfusion. In the observation group of 203 cases who had received intraoperative blood transfusion, there were 98 males and 105 females with an age of (61.0±20.7) years; in the control group of 299 cases who had not received intraoperative blood transfusion, there were 166 males and 133 females with an age of (57.7±19.0) years. Blood coagulation series such as D-dimer and fibrinogen were measured at admission, 1 day pre-operation, 1 day and 3 days postoperation. After operation, venous ultrasound examination of both lower limbs was performed to observe postoperative DVT in the patients. The 2 groups were compared in changes in coagulation series and occurrence of postoperative DVT.Results:There was no statistically significant difference in the preoperative general data between the 2 groups ( P>0.05), showing they were comparable. There was no significant difference between the observation group and the control group in the D-dimer level at admission or 1 day pre-operation ( P>0.05), but the D-dimer levels at 1 day and 3 days postoperation in the observation group [4.18 (2.35, 7.08) mg/L and (6.20±3.77) mg/L] were significantly higher than those in the control group [3.41 (1.91, 5.63) mg/L and (4.05±2.62) mg/L] ( P<0.05). There was no statistically significant difference in fibrinogen between the 2 groups at different time points ( P>0.05). The incidence of DVT in the observation group was 43.3% (88/203), significantly higher than that in the control group (32.8%, 98/299) ( P<0.05). Conclusion:As intraoperative blood transfusion can increase the level of D-dimer and thus the incidence of postoperative venous thrombosis in patients with orthopaedic trauma, we should pay more attention to the risk of postoperative DVT in patients receiving intraoperative blood transfusion.

Objective:To investigate the incidence of pre- and post-operative lower extremity deep venous thrombosis (DVT) in hospitalized patients with intertrochanteric fractures and to analyze the relevant risk factors.Methods:A retrospective case-control study was conducted to analyze the data of 218 patients with femoral intertrochanteric fractures admitted to Xi'an Honghui Hospital, Xi'an Jiaotong University from July 2015 to October 2017, including 85 males and 133 females. There were 85 males and 133 females, aged 32-102 years [(76.0±11.9)years]. Of the patients, 213 had open reduction and internal fixation, 4 partial hip arthroplasty, and 1 external fixation. All patients underwent deep venous ultrasound of the lower extremities before and after surgery to determine the occurrence of DVT. DVT of the lower extremities was divided into distal thrombosis, proximal thrombosis and mixed thrombosis. According to the preoperative and postoperative ultrasonography results, the patients were divided into thrombosis group [82 patients (37.6%) before operation, 128 patients (58.7%) after operation] and non-thrombosis group [136 patients (62.4%) before operation, 90 patients (41.3%) after operation]. Location of DVT were recorded before and after operation and outcome was evaluated. All patients were assessed for risk factors associated with thrombosis, including general patient data, time of surgery, tourniquet time, blood transfusion, blood loss, fluid volume, drainage, and serological markers. Multivariate Logistic regression analysis was used for detecting the risk factors.Results:The DVT rate was 37.6% preoperatively and increased to 58.7% postoperatively. The type of thrombosis was mainly distal DVT, which accounted for 86.6% and 90.6% of DVT before and after surgery, respectively. After the operation, 2.8% of the distal DVT extended above the popliteal vein. A total of 23.4% of the patients had no thrombosis before surgery, and distal, proximal, or mixed DVT occurred after surgery (22.0%, 0.5% and 0.9%, respectively). No fatal pulmonary embolism occurred. The univariate analysis showed no statistical differences between the preoperative thrombosis group and non-thrombosis group in terms of age, gender, fracture side, combined diseases, body mass index, American Society of Anesthesiologists (ASA) classification, admission D-dimer, and admission C-reactive protein (CRP) ( P>0.05), but the time from fracture to hospitalization and the time from fracture to surgery were significantly different between the two groups ( P<0.05). There were no statistical differences between the postoperative thrombosis group and the postoperative non-thrombosis group in age, gender, fracture side, combined diseases, body mass index, length of stay, ASA classification, surgical method, operation time, blood transfusion, blood loss, infusion volume, drainage volume, D-dimer on admission, and CRP on admission ( P>0.05), but the time from fracture to admission, time from fracture to surgery, D-dimer before surgery, D-dimer at day 1 after surgery, D-dimer at day 5 after surgery, and CRP at day 5 after surgery showed significant differences between the two groups ( P<0.05). Multivariate analysis results showed the time from fracture to hospitalization ( OR=1.109, 95% CI 1.003-1.225, P<0.05) and the time from fracture to surgery ( OR=1.090, 95% CI 1.007-1.180, P<0.05) were independent risk factors for preoperative DVT. The time from fracture to hospital ( OR=1.137, 95% CI 1.002-1.290, P<0.05) and 1 day postoperative D-dimer ( OR=1.087, 95% CI 1.033-1.142, P<0.05) were independent risk factors for postoperative DVT. Conclusions:For intertrochanteric fractures, distal DVT is the main type of thrombosis. Time from fracture to hospitalization is an independent risk factor of DVT before and after operation, and time from fracture to operation is an independent risk factor of DVT before operation. Early intervention (early admission and early surgery) may reduce the incidence of DVT.

Objective To investigate the incidence and risk factors of intraoperative deep venous thrombosis (DVT) in patients with multiple injuries.Methods A retrospective analysis was conducted of the 183 patients with multiple injuries who had been admitted to the Department of Orthopaedics and Trauma,Xi'an Honghui Hospital from January 2016 to November 2017.They were 117 males and 66 females,aged from 16 to 84 years (average,47.3 years).Craniocerebral injuries occurred in 16 cases,chest injuries in 24 cases,spinal injuries in 9 cases,pelvic acetabular fractures in 64 cases,upper limb fractures in 40 cases,and lower limb fractures in 145 cases.Venous ultrasonography of bilateral lower limbs was performed preoperatively and postoperatively to detect incidence of DVT.The patients were divided into a DVT group and a non-DVT group.The 2 groups were compared in terms of gender,age,interval from injury to surgery,D-dimer levels upon admission and discharge,operation time,intraoperative blood transfusion,injury severity scoring (ISS) and type of injury.After single-factor analysis was used to screen risk factors,multivariate logistic regression analysis was used to determine the main independent risk factors.Results The incidence of lower limb DVT in patients with multiple injuries was 42.08％ (77/183).Of the 77 DVT patients,12 had proximal thrombosis (6.56％) and 65 distal thrombosis (35.52％).Multivariate logistic regression analysis showed that age of ＞ 60 years,operative time for ≥2 hours,and presence of spinal injury were independent risk factors for DVT in patients with multiple injuries (P ＜ 0.05).Conclusions The incidence of lower limb DVT can be high in patients with multiple injuries.An age of ＞ 60 years,operation time for ≥2 hours and presence of spinal injury are independent risk factors for DVT in these patients.

Objective To investigate the clinical characteristics and risk factors of perioperative deep venous thrombosis (DVT) in fracture patients.Methods A retrospective case control study was conducted to analyze the clinical data of 147 patients with DVT diagnosed by color Doppler ultrasound or lower extremity deep venography from July 2015 to November 2017 in Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine.The patients were divided into proximal thrombosis group (including the popliteal vein) and distal thrombosis group according to the involvement site with the popliteal vein as reference.The proximal thrombosis group (56 patients) included 31 males and 25 females,aged 38-89 years,with an average age of 67.8 years.There were three patients with pelvic and acetabular fractures,39 with hip fractures,10 with femoral shaft fractures,three with periarticular fractures,and one with tibia and fibula fracture.According to the site of involvement,four patients had proximal vein thrombosis,and the other 52 patients had proximal combined with distal thrombosis.There were 44 patients with left thrombosis and 12 with right thrombosis.Thrombosis at femoral vein and above was found in 20 patients (7 with external iliac vein thrombosis),and thrombosis at popliteal vein was found in 36 patients.The distal thrombosis group (91 patients) consisted of 51 males and 40 females,aged 21-92 years,with an average of 63.6 years.There were 12 patients with pelvic and acetabular fractures,39 with hip fractures,four with femoral shaft fractures,16 with fractures surrounding knee joint,12 with tibia and fibula fractures,and eight with ankle joint fractures.There were 43 patients with left thrombosis and 48 with right thrombosis.The gender,age,fracture location,time from injury to operation,operation time,blood transfusion rate,thrombus side,D-dimer level before and after operation,and internal medical diseases were compared between the two groups.The risk factors with statistical significance were screened for multivariate Logistic regression analysis.Results In proximal thrombosis group,70％ (39/56) had hip fracture and 18％ (10/56) had femoral shaft fracture,while 43％ (39/91) had hip fracture and 4％ (4/91) had femoral shaft fracture in distal thrombosis group (P＜0.05).In the proximal thrombosis group,79％ (44/56) had thrombosis in the left lower extremity,which was much higher than that in the distal thrombosis group 47％ (43/91) (P ＜ 0.05).In proximal thrombosis group,77％ (43/56) received blood transfusion,which was higher than 39％ (35/91) in distal thrombosis group (P ＜0.05).D-dimer levels in proximal thrombosis group before and after operation [(8.5 ± 8.1) mg/L,(12.8 ± 9.7) mg/L],were higher than those in distal thrombosis group [(4.6 ± 3.8) mg/L,(7.2 ± 7.5) mg/L] (P ＜ 0.05).There were no significant differences in gender,age,time from injury to operation,operation time and internal medical complications between the two groups (P ＞0.05).Logistic regression analysis showed that hip fracture and femoral shaft fracture,left lower limb,blood transfusion,high D-dimer level before and after operation were risk factors for proximal thrombosis.Conclusions Proximal venous thrombosis is often combined with distal venous thrombosis.Hip fracture,femoral shaft fracture,left lower limb,blood transfusion,preoperative and postoperative high D-dimer levels have significant effects on proximal thrombosis.

Objective To investigate the incidence and risk factors of deep venous thrombosis in patients with open fracture of lower extremities.Methods A retrospective study was conducted to analyze the clinical data of 203 patients with open fracture of lower limbs admitted to Department of Orthopaedics and Trauma,Xi'an Jiangtong University Medical College Red Cross Hospital from January 2015 to November 2017.There were 75 males and 45 females,the average age was 47.3 years,and the age ranged from 18 to 63 years.Classification of open fracture sites of lower limbs:open fracture of femoral shaft in 59 cases;open fracture of tibia and fibula in 107 cases;open fracture of ankle in 37 cases.Gustilo classification of open fracture included 34 cases of type Ⅰ,71 cases of type Ⅱ and 98 cases of type Ⅲ.According to whether thrombosis occurs or not,the patients were divided into thrombosis group (n =63) and non-thrombosis group(n =140).The incidence of thrombosis was expressed as percentage (％).The age,fracture degree,injury type,Gustilo classification of open fracture,gender,body mass index (BMI),combined medical diseases,fracture site,preoperative and postoperative D-dimers were subjected to x2 test or Fisher's exact test.The test αt value was taken as 0.05 on both sides.P ＜ 0.05 suggested that the difference was statistically significant.Results The incidence of deep venous thrombosis in 63 cases of open fracture was 31.03％,of 63 DVT patients,5 were central thrombosis (7.93％),17 were mixed thrombosis (26.98％) and 41 were peripheral thrombosis (65.08％).The main type of thrombosis was peripheral thrombosis.There were significant differences in age,fracture degree,injury type and open fracture Gustilo type between the two groups of thrombus group and non thrombus group (P ＜ 0.05).Sex,BMI,internal medical diseases,fracture sites,and D-two polymer before and after operation were not statistically significant (P ＞0.05).Conclusions The incidence of DVT was higher in patients with open fracture of lower extremities,the main type of thrombosis was peripheral thrombosis.Age over 60 years old,high falling injury,2 or more fractures and comminuted fractures,open fractures Gustilo type Ⅲ was associated with DVT.

Objective To investigate the incidence and risk factors of deep venous thrombosis (DVT) in lower extremity in patients with tibial plateau fracture.Methods The data from 148 patients with tibial plateau fracture were retrospectively analyzed who had been admitted to the Department of Orthopaedic Trauma,Honghui Hospital between September 2014 and December 2017.They were 90 males and 58 females,aged from 19 to 83 years (average,47.2 ± 13.1 years).According to the Schatzker classification of tibial plateau fractures,24 cases belonged to type Ⅰ,17 to type Ⅱ,25 to type Ⅲ,29 to type Ⅳ,34 to type Ⅴ,and 19 to type Ⅵ.The incidence of DVT was detected by venous ultrasound of bilateral lower extremities before and after surgery.The factors related to the occurrence of DVT were statistically analyzed.Univariate analysis was used to determine risk factors,and multivariate logistic regression analysis was used to identify the primary independent risk factors.Results The preoperative DVT incidence was 43.92％ (65/148) and the postoperative DVT incidence 52.70％ (78/148).Distal thrombus predominated both preoperatively and postoperatively.Age (OR =1.043,95％ CI 1.015 ～ 1.072,P =0.002) and D-dimer level upon admission (OR =1.219,95％ CI 1.009 ～ 1.473,P =0.040) were independent risk factors for preoperative DVT formation;age (OR =1.075,95％ CI 1.042 ～ 1.110,P =0.000),operative time (OR =0.994,95％ CI 0.989～0.999,P=0.016),D-dimer level at 1 day postoperatively (OR=1.135,95％ CI 1.025～1.258,P =0.015) and at 3 days postoperatively (OR =1.366,95％ CI 1.008 ～ 1.853,P =0.044) were independent risk factors for postoperative DVT.Conclusions The incidence of DVT in the lower extremity may be high in patients with tibial plateau fracture.Distal thrombus is the main manifestation.In fracture patients,especially the middle-aged and elderly ones,dynamic monitoring of D-dimer level should be combined with lower extremity venous ultrasound for early diagnosis of DVT.In patients with lower extremity DVT,surgical progress should be accelerated on the basis of good surgical quality to reduce the incidence of postoperative lower extremity DVT.

Objective: To investigate the regularity in and risk factors for perioperative deep venous thrombosis (DVT) and the changes in plasma D-dimer in patients with tibiofibular fracture. Methods: A retrospective analysis was done of the 180 patients with tibiofibular fracture who had been treated at Department of Orthopaedics and Trauma, Xi'an Honghui Hospital from September 2014 to February 2018. They were 114 males and 66 females, aged from 16 to 83 years (average, 47.6 years). The levels of plasma D-dimer were detected at admission, one day preoperation, and 1, 3, 5 days postoperation. B-ultrasound examination of both lower extremities was performed before and after surgery. According to the results of B-ultrasound, the patients were divided into a DVT group and a non-DVT group. The 2 groups were compared in the plasma D-dimer levels measured at different time points. DVT risk factors were screened by univariate analysis, and multivariate logistic regression analysis was used to determine independent risk factors. Results: Of this cohort, 54 cases (30%) developed DVT and 39 cases (21.7%) did preoperation. Of the 39 cases (mixed DVT in one and distal DVT in 38 ones), DVT disappeared in 14 postoperation. Of the 40 cases (22.2%) of postoperative DVT (proximal DVT in one, mixed DVT in one and distal DVT in 38 ones), 15 developed newly postoperation. Multivariate logistic regression analysis showed that age, time from injury to operation, pre-operative and postoperative D-dimer elevation were independent risk factors for DVT in the patients. The D-dimer levels in the DVT group were significantly higher than in the non-DVT group at one day preoperation, and 1, 3, 5 days postoperation (P<0.05). The area under the receiver operating characteristic curve was 0.704. When the critical value of D-dimer was 1.4 mg/L, its sensitivity for DVT diagnosis was 0.944 and its specificity 0.246 (poor). When the concentration of D-dimer was 4.45 mg/L, its sensitivity for DVT diagnosis was 0.574 and its specificity 0.817 (the highest). Conclusions Perioperative DVT may happen in patients with tibiofibular fracture, mostly at the distal end beyond the popliteal vein. Clinically, patients who are advanced in age, have plasma D-dimer elevation at admission and after operation, and have waited long for operation should be alert to the occurrence of DVT. The plasma D-dimer level with a recommended threshold of 4.45 mg/L may have a certain diagnostic value for patients with tibiofibular fracture.

Human infection with avian influenza A (H7N9) is easy to induce severe acute respiratory distress syndrome (ARDS), and traditional mechanical ventilation cannot correct hypoxemia, so patients may die from multiple organ failure (MOF) caused by persistent hypoxia. Extracorporeal membrane oxygenation (ECMO) can provide effective respiratory support and win time for the treatment of severe H7N9. The first case of severe H7N9 in Guangdong Province in 2018 was admitted to Zhongshan Hospital Affiliated to Sun Yat-sen University. The case was insult with severe ARDS caused by H7N9, the traditional mechanical ventilation could not correct hypoxemia, and the lung condition gradually improved with ECMO assistance. After 13 days of ECMO support, the patient was successfully weaned from ECMO and was transferred to a general ward after 55 days. After 102 days of rehabilitation, the patient was discharged from hospital and followed up for 2 months, who was in good health and had a good quality of life. This article states the diagnosis and treatment of severe H7N9 in details, providing experience for the treatment of severe H7N9 in the future.

Objective To investigate the incidence of and risk factors for deep venous thrombosis (DVT) at the uninjured limb during hospitalization in patients with lower extremity fracture. Methods The clinical data were retrospectively analyzed of the 494 patients who had been hospitalized for lower extremity fracture at Department of Orthopedics, Honghui Hospital from September 1, 2014 to October 1, 2017. They were 228 males and 266 females with an average age of 58.9 ± 18.9 years ( from 16 to 94 years ) . 290 fractures occurred proximally to the knee, 101 fractures around the knee and 103 fractures distally to the knee. They received anticoagulant prophylaxis or treatment during hospitalization. After operation, they were examined with Doppler sonography for bilateral lower limbs to detect occurrence of thrombus. The incidence of DVT at the uninjured limb during hospitalization was recorded and its possible risk factors were analyzed statistically. The possible risk factors ( gender, age, fracture type, body mass index, concomitant internal disease, time from injury to surgery, time from surgery to discharge, American Society of Anesthesiologists rating, operation duration, blood loss, fluid infusion volume and D-dimer level ) were screened by single factor logistic regression analysis and the major independent risk factors were determined by multi-factor logistic re-gression analysis.Results DVT occurred at the injured limb during hospitalization in 237 cases ( 47.97%). Of them, 221 ( 44.74%) had peripheral thrombus, 7 central thrombus ( 1.42%) and 9 mixed thrombus ( 1.82%). DVT occurred at the uninjured limb during hospitalization in 98 cases ( 19.84%). Of them, 90 (18.2%) had peripheral thrombus, one central thrombus (0.2%) and 7 mixed thrombus (1.4%). Of the 98 patients with DVT at the uninjured limb, 74 (75.51%) had DVT at both lower limbs and 24 (24.49%) had DVT only at the uninjured limb. Age and D-dimer level one day after surgery were independent risk factors for DVT at the uninjured limb during hospitalization. Conclusions The incidence of actual DVT at the unin-jured limb in patients with lower extremity fracture cannot be ignored in spite of use of anticoagulants for pro-phylaxis or treatment during hospitalization. We should also be aware that age and D-dimer level one day after surgery are independent risk factors for DVT at the uninjured limb during hospitalization.