Analysis of Risk Factors for Postoperative Deep Vein Thrombosis in Traumatic Spinal Fracture Complicated with Spinal Cord Injury

Analysis of Risk Factors for Postoperative Deep Vein Thrombosis in Traumatic Spinal Fracture Complicated with Spinal Cord Injury | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of Risk Factors for Postoperative Deep Vein Thrombosis in Traumatic Spinal Fracture Complicated with Spinal Cord Injury Diao Yang, Shiwen Chen, Can Zhuo, Haidan Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4497481/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The purpose of this study is to investigate the risk factors for postoperative DVT in patients with traumatic spinal fractures complicated with Spinal Cord Injury(SCI). We conducted a retrospective analysis of 110 patients with traumatic spinal fractures and SCI admitted to our hospital from March 2021 to April 2024. DVT was diagnosed usingr ultrasound.Patient history, general data, surgical data, laboratory tests, and thromboelastogram (TEG) results were collected. The patients were divided into a DVT group and a non-DVT group according to the results of color ultrasound one week after surgery. The risk factors and diagnostic value were analyzed using binary logistic regression and receiver operating characteristic (ROC) curves in both univariate and multivariate analyses. The incidence of postoperative DVT was 52.7% (58 / 110). Seven patients (6.4%) had proximal thrombus, and 51 patients had distal thrombus (46.4%). Multivariate and ROC analysis results showed that D-dimer, lower extremity, duration of bed, and MA values were independent risk factors for DVT in SCI, with D-dimer having the highest diagnostic value (AUC = 0.883). The AUC values for lower extremity, duration of bed, and MA were 0.731, 0.750, and 0.625. In conclusion, Postoperative D-dimer>5.065mg/l, lower extremity< 3, duration of bed, and MA value are independent risk factors for postoperative DVT in SCI patients, D-dimer having the highest diagnostic value. spinal cord injury deep vein thrombosis spinal fracture risk factor D-dimer Figures Figure 1 Introduction Traumatic spinal fracture refers to spinal fracture caused by high energy injuries such as traffic accidents, falling, and heavy objects. It is often accompanied by spinal cord injury(SCI), which can lead to physical disability and even death and increase the economic burden.Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively known as venous thromboembolism (VTE), are complications associated with SCI. SCI usually requires surgical treatment, and the risk of postoperative DVT is high. 1 Different studies have reported that the incidence of DVT varies from 10–90%. 2 , 3 However, DVT is insidious, and some patients are asymptomatic and easily overlooked. When patients experience symptoms such as lower limb pain, swelling, dyspnea, or chest pain, it often suggests DVT. In severe cases, pulmonary embolism may occur, endangering the patient's life. 4 Few studies have investigated the risk factors for postoperative DVT in SCI, and no consistent conclusions have been reached. These patients generally experience high-energy injuries, prolonged bed rest, traumatic stress, spinal cord injury, and multiple fractures, all of which promote DVT. Some scholars have used mechanical and drug prevention methods for DVT in patients with spinal fractures, achieving certain curative effects but not ideal prevention outcomes. 5 Therefore, identifying the risk factors for postoperative DVT in patients with traumatic spinal fractures complicated by SCI and implementing corresponding preventive measures to reduce the incidence of DVT and improve the prognosis of patients with SCI is of great significance. Consequently, we conducted a study to identify the risk factors affecting DVT after SCI and explored the diagnostic value of different risk factors to provide a reference for diagnosis and treatment. Materials and Methods Study and Population Collect patients from March 2021 to April 2024 with spinal cord injuries caused by high-energy injuries. Inclusion criteria: no DVT during preoperative examination; patients with spinal fractures and spinal cord injuries caused by high-energy injuries (falling injuries, traffic accidents, heavy object injuries); patients without hemophilia, abnormal coagulation,or lower extremity varicose veins; those who received chemical and mechanical DVT prophylaxis after admission. Exclusion criteria: no spinal cord injury; fractures at other sites or old spinal fractures > 4 weeks; osteoporotic or pathological spinal fractures; patients with continuous anticoagulation abnormalities; preoperative diagnosis of DVT; previous history of venous thromboembolism; and patients with incomplete medical records and imaging data. A total of 110 patients were included, comprising 90 males and 20 females. The patients' ages ranged from 18 to 84 years. The fracture sites were distributed as follows: 36 cervical, 18thoracic, 27lumbar, 23 thoracolumbar, 3 cervical with thoracic spine, 2 cervical with lumbar spine, and 1 involving cervical, thoracic, and lumbar spine. None of the patients developed epidural hematoma or pulmonary embolism. The study was approved by the hospital ethics committee, and all patients agreed to participate in the study and signed the relevant consent documents. Research Technique The hospital routinely applied the Caprini venous thrombosis risk assessment scale to assess DVT risk. All patients with spinal cord injury were classified as high-risk patients.After excluding those with subarachnoid hemorrhage,lower limb skin damage, bleeding tendency,or abnormal coagulation function,all patients received low molecular weight heparin (LMWH) (5000U, once a day,subcutaneous injection, Nanjing Jian You Company, China) and mechanical prevention (intermittent pneumatic pressure device, once a day, 30 minutes each time) to prevent DVT until postoperative mobilization.LMWH injection was stopped 12h before and 24h after surgery.We divided DVT into two types: proximal DVT (in the popliteal vein or its proximal end) and distal DVT (in the distal popliteal vein). The presence of thrombus both proximal and distal to the popliteal vein was defined as the proximal DVT. All patients underwent bilateral limb venous color ultrasound examination after admission, and within one week after surgery. Patients were divided into DVT group and non-DVT group according to the results of postoperative bilateral DVT ultrasound. Non-DVT patients received 5000U of LMWH and mechanical prevention once daily. DVT patients received 5000U of LMWH twice daily and discontinued mechanical prevention. If there were anticoagulant contraindications or proximal thrombosis, a vascular surgical consultation was requested to assist in developing an individual treatment plan to prevent pulmonary embolism. Collecting Data General data:age,gender,comorbidities (hypertension,coronary heart disease, diabetes), smoke, lower extremity(< 3/≥3), time from fracture to surgery, duration of bed, operation time, blood loss, and blood transfusion. Laboratory data: D-dimer (measured on the first day post-surgery), C-reactive protein(CRP), hemoglobin(HGB), neutrophil(NEUT), platelet count(PLT),red cell volume distribution width(RDW), fibrinogen(FIB), thrombin time(TT), activated partial thromboplastin time(APTT), prothrombin time(PT), hypoproteinemia.Thromboelastogram (TEG): reaction time (R) (4–9 min), coagulation time (K) (1–3 min), coagulation angle (α) (53–72°), and maximum amplitude (MA) value (50–70 mm). Statistical Analysis Statistical analysis were performed with SPSS (Version 25,IBM SPSS Inc.,Chicago,IL,USA).Continuous variables were presented as mean ± standard deviation and compared with an independent t test. Categorical variables are shown proporproportion and compared using the chi-square test. Univariate variables with a significant index (P < 0.05) were included in the multivariate analysis. The diagnostic value of each risk factor was evaluated by analyzing the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). Test level of P < 0.05 was considered statistically significant. Results The Incidence of Postoperative DVT The incidence of postoperative DVT in 110 patients with traumatic spinal fractures combined with SCI was 52.7% (58/110). Seven patients (6.4%) had proximal thrombus, and 51 patients had distal thrombus (46.4%). Inferior vena cava filters were placed in all seven patients with proximal thrombi, and none of the patients developed pulmonary embolism or epidural hematoma. Univariate Analysis of Postoperative DVT The general data of the two groups are shown in Table 1 . The DVT group had Duration of bed of 14.28 ± 2.76 minutes, while the non-DVT group had 10.96 ± 3.75 minutes (P < 0.05). Operation time was 280.78 ± 100.166 minutes in the DVT group and 243.58 ± 78.59 minutes in the non-DVT group (P < 0.05). There were significant differences in lower extremity and the incidence of coronary heart disease between the two groups (P < 0.05). Compared with the non-DVT group, DVT group had decreased lower extremity,longer duration of bed,operation time,and higher incidence of coronary heart disease, making them more prone to DVT. There were no significant differences in age, sex, hypertension, diabetes, smoke, time from fracture to surgery, blood loss, and blood transfusion (P > 0.05). Table 1 Comparison general data of two groups of patients Variables DVT Group (n = 58) Non-DVT Group (n = 52) a Test Statistics P Value Age(years) 54.52 ± 11.1 49.73 ± 15.61 -1.87 0.065 Gender (Male/Female) 49/9 41/11 0.586 0.444 Comorbidities Hypertension(%) 12/46 5/47 2.573 0.109 Coronary heart disease (%) 15/43 3/49 8.088 0.004 Diabetes(%) 6/52 7/45 0.256 0.613 Smoke(%) 24/34 13/39 3.295 0.069 b Lower extremity (< 3/≥3) 48/10 19/33 24.6 < 0.001 Time from fracture to surgery (days) 7.12 ± 5.5 5.46 ± 4.58 -1.708 0.09 Duration of bed (days) 14.28 ± 2.76 10.96 ± 3.75 -5.248 < 0.001 Operation time(min) 280.78 ± 100.16 243.58 ± 78.59 -2.178 0.032 Blood loss(ml) 600.67 ± 450.25 325.32 ± 220.56 -1.718 0.089 Blood transfusion (yes/no) 48/10 36/16 2.78 0.095 a tValue or χ²Value; b Manual muscle test score(0–5) Laboratory results from the two groups were compared, as shown in Table 2 .D-dimer9.93 ± 5.79mg/l in DVT group and 2.99 ± 3.11mg/l in non-DVT group (P < 0.05). CPR was 41.98 ± 40.08 mg/l in the DVT group and 20.15 ± 15.04mg/l in the non-DVT group (P < 0.05). DVT group NEUT10.57 ± 5.25×10^9 / l, non-DVT group NEUT 8.58 ± 4.5×10^9/l, NEUT difference was significant (P < 0.05). RDW was 13.46 ± 1.28% in the DVT group and 12.85 ± 1.09% in the non-DVT group, with a significant difference in RDW (P < 0.05). FIB was significant in DVT group FIB3.92 ± 1.57g/l and non-DVT group FIB3.32 ± 1.32g/l (P < 0.05). In the DVT group, PT13.88 ± 1.25s,PT and non-DVT PT13.46 ± 0.82s(P < 0.05).Similarly, hypoproteinemia was significantly between the two groups (P 0.05). Table 2 Comparison of laboratory results between two groups of patients Variables DVT Group (n = 58) Non-DVT Group (n = 52) a Test Statistics P Value D-dimer(mg/l) 9.93 ± 5.79 2.99 ± 3.11 -7.939 < 0.001 CRP(mg/l) 41.98 ± 40.08 20.15 ± 15.04 -3.856 < 0.001 HGB(g/l) 114.72 ± 23.61 122.43 ± 22.37 1.751 0.083 NEUT(×10^9/l) 10.57 ± 5.25 8.58 ± 4.5 -2.122 0.036 PLT(×10^9/l) 177.28 ± 94.83 187.75 ± 83.45 0.612 0.542 RDW(%) 13.46 ± 1.28 12.85 ± 1.09 -2.703 0.008 FIB(g/l) 3.92 ± 1.57 3.32 ± 1.32 -2.18 0.031 TT(s) 17.19 ± 7.44 16.92 ± 1.24 -0.258 0.797 APTT(s) 37.09 ± 6.38 35.43 ± 4.72 1.531 0.129 PT(s) 13.88 ± 1.25 13.46 ± 0.82 -2.124 0.036 b Hypoproteinemia(yes/no) 47/11 31/21 6.098 0.014 a tValue or χ²Value b Hypoproteinemia is defined as plasma albumin level of less than 35g/l or plasma total protein less than 60g/l Comparing the two TEG groups, as shown in Table 3 . R significant difference between DVT group 3.51 ± 0.83min and non-DVT group 4.17 ± 0.81min (P < 0.05). K was significant for 1.57 ± 0.79min in DVT and non-DVT in 1.92 ± 0.61min (P < 0.05). Angle was Angle67.52 ± 6.73°. DVT and Angle64.84 ± 5.99°. Angle (P < 0.05). MA difference for DVT 61.95 ± 10.19mm and non-DVT MA58.16 ± 6.79mm (P < 0.05). Table 3 Comparison the TEG of two groups of patients Variables DVT Group (n = 58) Non-DVT Group (n = 52) a Test Statistics P Value R(min) 3.51 ± 0.83 4.17 ± 0.81 4.220 0.065 K(min) 1.57 ± 0.79 1.92 ± 0.61 2.65 0.009 Angle (°) 67.52 ± 6.73 64.84 ± 5.99 -2.214 0.029 MA(mm) 61.95 ± 10.19 58.16 ± 6.79 -2.339 0.021 a tValue Multivariate Analysis of Postoperative DVT Binary logistic regression analysis of coronary heart disease, muscle strength of Lower extremity,duration of bed, operation time, D-dimer, CPR, NEUT, RDW, FIB, PT, Hypoproteinemia, R, K, Angle, MA was performed to explore the risk factors of DVT. As shown in Table 4 .The results show that D-dimer (OR,1.392;95%CI 1.020–1.899;P < 0.05), Lower extremity (OR,10.051;95%CI 1.509–20.345; P < 0.05), Duration of bed (OR, 1.586; 95%CI 1.144-2.200; P < 0.05), MA (OR,1.307; 95%CI 1.009–1.695; P < 0.05) were independent risk factors for postoperative DVT in patients with traumatic spinal fractures combined with SCI. Table 4 Multivariate analysis of risk factors for DVT R isk factors β SE Wald Exp(β) 95%CI P Value D-dimer(mg/l) 0.331 0.159 4.346 1.392 1.020–1.899 0.037 Lower extremity 3.403 1.526 4.972 10.051 1.509–20.345 0.026 Duration of bed (days) 0.461 0.167 7.641 1.586 1.144-2.200 0.006 MA(mm) 0.268 0.132 4.102 1.307 1.009–1.695 0.043 ROC Analysis of Different Risk Factors We used ROC analysis to determine the diagnostic value of different risk factors in postoperative DVT. The ROC curves for the four risk factors are shown in Fig. 1 . The AUC values indicate the diagnostic value of the predictors. D-dimer had the highest diagnostic value (AUC = 0.883). The AUC values for Lower extremity, Duration of bed, and MA were 0.731,0.75, and 0.625, respectively (Table 5 ). For The diagnostic cut-off value was determined by the Youden index.The diagnostic cut-off value for D-dimer was 5.065 mg/L, with sensitivity of 81% and specificity of 82.7%. Other diagnostic cut-off value lower extremity 12.5 days, MA > 66.25mm. Table 5 The ROC results of different factors Risk factors a Cut-off value Sensitivity Specificity AUC SE 95%CI P Value D-dimer(mg/l) 5.065 81% 82.7% 0.883 0.032 0.821–0.945 < 0.001 Lower extremity 3 82.8% 63.5% 0.731 0.049 0.634–0.828 < 0.001 Duration of bed (days) 12.5 82.8% 69.2% 0.75 0.049 0.653–0.846 < 0.001 MA(mm) 66.25 37.9% 64.2% 0.625 0.054 0.653–0.846 0.024 a The cut-off points of scores were determined by the Youden index Discussion Our retrospective findings indicate that despite chemical and mechanical prevention of DVT, the risk of postoperative DVT in traumatic spinal fractures was high (52.7%), 7 (6.4%) proximal thrombus and 51 distal thrombus (46.4%). None of the patients developed pulmonary embolism or epidural hematoma. D-dimer,lower extremity, duration of bed and MA were independent risk factors for developing DVT. We also found that D-dimer had the highest diagnostic value among the four factors. DVT and PE, collectively called venous thromboembolism syndrome, is one of the common complications after spinal fracture and spinal cord injury. 6 According to Virchow's triad, the three factors contributing to thrombosis are a hypercoagulable state of blood, endothelial injury of the vascular wall, and blood flow stasis. 7 , 8 Patients with SCI have motor and sensory dysfunction below the injury plane and a loss of muscle strength in both lower limbs. Some patients have complete spinal cord injury, which will seriously affect the sympathetic control of cardiac function, leading to the reduction of myocardial contractility, reduced venous blood supply of the lower limbs, reduced effective blood volume, increased blood viscosity, and hypercoagulable blood. 9 Patients with spinal fracture need to brake in bed, coupled with the lower limb motor dysfunction caused by spinal cord injury factors, weakened the function of lower limb muscle pump, slow venous blood reflux, blood stasis, easy to form a hypercoagulation state of blood, damaged vascular endothelium, platelet hyperfunction, which promotes the occurrence of DVT. 10 – 14 Some studies have reported that the incidence of spinal cord injury is about 10.3% -62.5%. We believe that the incidence is related to the detection method and time of detection. We studied 110 patients with surgical treatment for spinal cord injury, and the incidence of DVT was 52.7%. In our study, age, hypertension, diabetes, and smoke were not found to be independent risk factors for postoperative DVT in SCI patients, which is consistent with the conclusions of some scholars. 15 , 16 It was also found that coronary heart disease may affect the occurrence of DVT. This may be because such patients are older and have poor vascular elasticity, but combined coronary heart disease is not an independent risk factor for DVT.Coagulation indicators,HGB,albumin,and inflammation indicators in laboratory tests are not independent risk factors for DVT formation. In our study, D-dimer > 5.065 mg/L on the first postoperative day was a risk factor for DVT after SCI. D-dimer is mainly a specific degradation product generated by the hydrolysis of fibrin monomer after cross-linking by activation factor, indicating a hypercoagulable state complicated by fibrinolysis. D-dimer is an important test for DVT diagnosis, with high negative predictive value and sensitivity, but its specificity is low because D-dimer levels can also increase in postoperative, infection, cancer, trauma, and other conditions. 17 , 18 Although affected by many factors, the D-dimer is still considered the most powerful indicator of venous thromboembolic events. 19 Surgical procedures increase D-dimer levels, and changes are more pronounced in patients with DVT. 20 Lv et al 21 studied 175 cervical fractures with spinal cord injuries found D-dimer > 1.02mg/L on admission as an independent risk factor for admission of DVT in SCI patients, with sensitivity 84.21% and specificity 78.10%. Masuda et al, 22 using a prospective study of 211 patients with SCI, showed that 22 patients (10.4%) developed DVT. D-dimer could be used to predict the likelihood of DVT in acute cervical fracture with SCI. The optimal screening time was 2 weeks after injury, and the optimal threshold level of D-dimer for DVT 16µg/dL.On the first postoperative day, our D-dimer > 5.065mg/L had the highest diagnostic value (AUC = 0.883), with a sensitivity of 81% and a specificity of 82.7%. Our study only included the discussion of D-dimer on the first postoperative day,and factors such as the stimulation of surgery,the stimulation of trauma,the release of inflammatory mediators,anesthesia, intraoperative bleeding, and postoperative rehydration may all lead to the elevation of D-dimer. 23 Our study showed that lower extremity < 3 is one of the independent risk factors for postoperative DVT in SCI patients. Decreased lower extremity causes reduced muscle pump function, reduced venous blood return in the lower limbs, blood stasis, and a higher propensity for DVT. 24 Wang et al 25 research the predictors of preoperative deep vein thrombosis in 429 patients with high-energy injury suggested that lower extremity < 3 was an independent predictor of preoperative DVT,and that reduced lower extremity caused an 8.257-fold increased risk of preoperative DVT. Some scholars have studied the ossification of the posterior longitudinal ligament with acute spinal cord injury, showing that the impairment of lower limb motor function is a risk factor for DVT in the lower limbs. 26 Imyro et al 27 research 698 lumbar degenerative surgeries found that preoperativelower extremity < 3 was closely associated with the occurrence of DVT, which was consistent with our results. 27 Patients with spinal cord injury with dinnervation, complete loss of movement and sensation below the plane of injury, incomplete SCI patients with lower limb motor dysfunction.Our study patients with lower extremity < 3, the risk of postoperative DVT increased 10-fold.Therefore, patients admitted with lower extremity < 3 should take active measures to prevent DVT and reduce its incidence. Prolonged duration of bed and reduced activity of the lower limbs can affect venous blood flow in the lower limbs, leading to less reflux, slower blood flow, blood stasis, and an increased likelihood of forming a hypercoagulable state, which can lead to DVT. 24 Wang et al 5 studied the risk factors for postoperative DVT in patients with thoracolumbar fractures due to high-energy injury under LMWH prevention, suggesting that time in bed stay > 12 days was an independent risk factor for postoperative DVT. In our study, the duration of bed was 14.28 ± 2.76 days in the DVT group and 10.96 ± 3.75 days in the non-DVT group. Duration of bed > 12.5 days in SCI patients was an independent risk factor for postoperative DVT. After spinal fracture, the spine lacks stability, and patients with long-term bed from admission to surgery, especially those partially paralyzed with complete loss of lower limb motor function, are more prone to blood stasis and have a higher incidence of DVT in the lower limbs. Therefore, patients with SCI who retain lower limb motor function should get out of bed as soon as possible for functional exercise to prevent DVT. The MA value in TEG refers to the maximum blood clot strength and represents the maximum amplitude of the marker curve. This value reflects the maximum mechanical strength and stability of the blood clot during coagulation. The blood clot is composed of fibrin and platelets, and the amount, strength, and condensation of these components affect the MA value. However, the contribution of platelets to the MA value is larger than that of fibrinogen. 28 Liu et al 29 in elderly fracture patients found that increased MA values in TEG suggested hypercoagulable blood. In our study, we found that the MA value was 61.95 ± 10.19 mm in the DVT group and 58.16 ± 6.79 mm in the non-DVT group. The best cut-off value of MA for predicting the formation of DVT was 66.25 mm. Our current study has some limitations. First, this was a retrospective study with selection bias. Secondly, our sample size was small, and some influencing factors were not included in the study. Third, we only discussed the impact of D-dimer measurements on the first postoperative day; multiple tests before operation and on postoperative days 1, 3, and 5 should be included in future studies. Finally, future prospective studies with larger samples and multiple centers are needed to confirm our results. Conclusion Postoperative D-dimer>5.065mg/l, lower extremity < 3, duration of bed, MA value are independent risk factors for postoperative lower limb DVT in SCI patients, with D-dimer having the highest diagnostic value. Abbreviations DVT Deep vein thrombosis SCI Spinal Cord Injury ROC Receiver operating characteristic RDW Red blood cell distribution width Hypoproteinemia Plasma albumin level of less than 35g/l or plasma total protein less than 60g/l AUC Area under the curve LMWH Low molecular weight heparin OR Odds ratio Declarations Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethical Approval The Ethics Committee of Yichang Central People's Hospital approved this study. Funding None Author Contribution D.Y. :Formal analysis, Writing - review & editing. SW.C.: Data curation, Writing-original draft.C. Z.:Software,Validation. HD. C.: Conceptualization, Methodology, Software,Visualization.All authors reviewed the manuscript. Acknowledgements None References Manga S, Younes ABH, Dioum M, et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4497481","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":315117524,"identity":"4a9c722c-7236-4cd8-828d-41df5f8a54d1","order_by":0,"name":"Diao Yang","email":"","orcid":"","institution":"China Three Gorges University, Yichang Central People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Diao","middleName":"","lastName":"Yang","suffix":""},{"id":315117525,"identity":"985ee070-e711-49c8-b4df-bb114512749e","order_by":1,"name":"Shiwen Chen","email":"","orcid":"","institution":"China Three Gorges University, Yichang Central People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shiwen","middleName":"","lastName":"Chen","suffix":""},{"id":315117526,"identity":"b56d6b1c-0b87-456e-8bf2-4542269316b8","order_by":2,"name":"Can Zhuo","email":"","orcid":"","institution":"China Three Gorges University, Yichang Central People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Can","middleName":"","lastName":"Zhuo","suffix":""},{"id":315117527,"identity":"05e8e762-1519-4600-aff5-c5cf1f749474","order_by":3,"name":"Haidan Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYDADA4bkAwwJJGpJSyBZS44BkSqP9x68zVNzR96cPefzh4c77Bj427vxW2Zw5lyyNc+xZ4Y7e95uk0g8k8wgcebsBrxazG7kmEnzsB1OMLiRu40hsY2ZwUAil4CW+2+AWv6BtOQ8/pDYVk+Elhs8ZtK8bWAtDBKJbYcJa7E/k2NsObfvsOGGM8/MgFqO8xD0i2T7GcMbb74dljc4nvz448+2ajn+9l78WkBAApnDQ1A5hpZRMApGwSgYBRgAAAeLSsINH/RwAAAAAElFTkSuQmCC","orcid":"","institution":"China Three Gorges University, Yichang Central People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Haidan","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2024-05-29 13:44:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4497481/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4497481/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58759853,"identity":"7a9f3be4-8050-40cb-86ea-925384f7a6e9","added_by":"auto","created_at":"2024-06-20 18:46:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":76990,"visible":true,"origin":"","legend":"\u003cp\u003eThe ROC curves of different risk factors\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4497481/v1/08d84646e1d5aa2cb9d39b32.png"},{"id":58841434,"identity":"b038fc49-855c-4acd-a71b-5c989fc29d5b","added_by":"auto","created_at":"2024-06-21 23:31:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":628902,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4497481/v1/0ec4c166-8bf0-4a3f-9f80-3ca9234ac178.pdf"},{"id":58759857,"identity":"3ef166d0-588c-4265-845b-3f924ce2f546","added_by":"auto","created_at":"2024-06-20 18:46:11","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":27060,"visible":true,"origin":"","legend":"","description":"","filename":"Data.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4497481/v1/8b9b61879afbaf30b2cf2652.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of Risk Factors for Postoperative Deep Vein Thrombosis in Traumatic Spinal Fracture Complicated with Spinal Cord Injury","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTraumatic spinal fracture refers to spinal fracture caused by high energy injuries such as traffic accidents, falling, and heavy objects. It is often accompanied by spinal cord injury(SCI), which can lead to physical disability and even death and increase the economic burden.Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively known as venous thromboembolism (VTE), are complications associated with SCI. SCI usually requires surgical treatment, and the risk of postoperative DVT is high.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Different studies have reported that the incidence of DVT varies from 10\u0026ndash;90%. \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003eHowever, DVT is insidious, and some patients are asymptomatic and easily overlooked. When patients experience symptoms such as lower limb pain, swelling, dyspnea, or chest pain, it often suggests DVT. In severe cases, pulmonary embolism may occur, endangering the patient's life.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Few studies have investigated the risk factors for postoperative DVT in SCI, and no consistent conclusions have been reached. These patients generally experience high-energy injuries, prolonged bed rest, traumatic stress, spinal cord injury, and multiple fractures, all of which promote DVT. Some scholars have used mechanical and drug prevention methods for DVT in patients with spinal fractures, achieving certain curative effects but not ideal prevention outcomes. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003eTherefore, identifying the risk factors for postoperative DVT in patients with traumatic spinal fractures complicated by SCI and implementing corresponding preventive measures to reduce the incidence of DVT and improve the prognosis of patients with SCI is of great significance. Consequently, we conducted a study to identify the risk factors affecting DVT after SCI and explored the diagnostic value of different risk factors to provide a reference for diagnosis and treatment.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy and Population\u003c/h2\u003e \u003cp\u003eCollect patients from March 2021 to April 2024 with spinal cord injuries caused by high-energy injuries. Inclusion criteria: no DVT during preoperative examination; patients with spinal fractures and spinal cord injuries caused by high-energy injuries (falling injuries, traffic accidents, heavy object injuries); patients without hemophilia, abnormal coagulation,or lower extremity varicose veins; those who received chemical and mechanical DVT prophylaxis after admission. Exclusion criteria: no spinal cord injury; fractures at other sites or old spinal fractures\u0026thinsp;\u0026gt;\u0026thinsp;4 weeks; osteoporotic or pathological spinal fractures; patients with continuous anticoagulation abnormalities; preoperative diagnosis of DVT; previous history of venous thromboembolism; and patients with incomplete medical records and imaging data.\u003c/p\u003e\u003cp\u003eA total of 110 patients were included, comprising 90 males and 20 females. The patients' ages ranged from 18 to 84 years. The fracture sites were distributed as follows: 36 cervical, 18thoracic, 27lumbar, 23 thoracolumbar, 3 cervical with thoracic spine, 2 cervical with lumbar spine, and 1 involving cervical, thoracic, and lumbar spine. None of the patients developed epidural hematoma or pulmonary embolism. The study was approved by the hospital ethics committee, and all patients agreed to participate in the study and signed the relevant consent documents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eResearch Technique\u003c/h2\u003e \u003cp\u003eThe hospital routinely applied the Caprini venous thrombosis risk assessment scale to assess DVT risk. All patients with spinal cord injury were classified as high-risk patients.After excluding those with subarachnoid hemorrhage,lower limb skin damage, bleeding tendency,or abnormal coagulation function,all patients received low molecular weight heparin (LMWH) (5000U, once a day,subcutaneous injection, Nanjing Jian You Company, China) and mechanical prevention (intermittent pneumatic pressure device, once a day, 30 minutes each time) to prevent DVT until postoperative mobilization.LMWH injection was stopped 12h before and 24h after surgery.We divided DVT into two types: proximal DVT (in the popliteal vein or its proximal end) and distal DVT (in the distal popliteal vein). The presence of thrombus both proximal and distal to the popliteal vein was defined as the proximal DVT. All patients underwent bilateral limb venous color ultrasound examination after admission, and within one week after surgery. Patients were divided into DVT group and non-DVT group according to the results of postoperative bilateral DVT ultrasound. Non-DVT patients received 5000U of LMWH and mechanical prevention once daily. DVT patients received 5000U of LMWH twice daily and discontinued mechanical prevention. If there were anticoagulant contraindications or proximal thrombosis, a vascular surgical consultation was requested to assist in developing an individual treatment plan to prevent pulmonary embolism.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eCollecting Data\u003c/h2\u003e \u003cp\u003eGeneral data:age,gender,comorbidities (hypertension,coronary heart disease, diabetes), smoke, lower extremity(\u0026lt;\u0026thinsp;3/\u0026ge;3), time from fracture to surgery, duration of bed, operation time, blood loss, and blood transfusion. Laboratory data: D-dimer (measured on the first day post-surgery), C-reactive protein(CRP), hemoglobin(HGB), neutrophil(NEUT), platelet count(PLT),red cell volume distribution width(RDW), fibrinogen(FIB), thrombin time(TT), activated partial thromboplastin time(APTT), prothrombin time(PT), hypoproteinemia.Thromboelastogram (TEG): reaction time (R) (4\u0026ndash;9 min), coagulation time (K) (1\u0026ndash;3 min), coagulation angle (α) (53\u0026ndash;72\u0026deg;), and maximum amplitude (MA) value (50\u0026ndash;70 mm).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis were performed with SPSS (Version 25,IBM SPSS Inc.,Chicago,IL,USA).Continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and compared with an independent t test. Categorical variables are shown proporproportion and compared using the chi-square test. Univariate variables with a significant index (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were included in the multivariate analysis. The diagnostic value of each risk factor was evaluated by analyzing the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). Test level of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eThe Incidence of Postoperative DVT\u003c/h2\u003e \u003cp\u003eThe incidence of postoperative DVT in 110 patients with traumatic spinal fractures combined with SCI was 52.7% (58/110). Seven patients (6.4%) had proximal thrombus, and 51 patients had distal thrombus (46.4%). Inferior vena cava filters were placed in all seven patients with proximal thrombi, and none of the patients developed pulmonary embolism or epidural hematoma.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eUnivariate Analysis of Postoperative DVT\u003c/h2\u003e \u003cp\u003eThe general data of the two groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The DVT group had Duration of bed of 14.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76 minutes, while the non-DVT group had 10.96\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75 minutes (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Operation time was 280.78\u0026thinsp;\u0026plusmn;\u0026thinsp;100.166 minutes in the DVT group and 243.58\u0026thinsp;\u0026plusmn;\u0026thinsp;78.59 minutes in the non-DVT group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There were significant differences in lower extremity and the incidence of coronary heart disease between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Compared with the non-DVT group, DVT group had decreased lower extremity,longer duration of bed,operation time,and higher incidence of coronary heart disease, making them more prone to DVT. There were no significant differences in age, sex, hypertension, diabetes, smoke, time from fracture to surgery, blood loss, and blood transfusion (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison general data of two groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDVT Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-DVT Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eTest Statistics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.52\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.73\u0026thinsp;\u0026plusmn;\u0026thinsp;15.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (Male/Female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49/9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41/11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12/46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5/47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15/43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6/52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoke(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24/34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13/39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003eb\u003c/sup\u003eLower extremity\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;3/\u0026ge;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48/10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19/33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime from fracture to surgery (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.12\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.46\u0026thinsp;\u0026plusmn;\u0026thinsp;4.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of bed (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.96\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-5.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time(min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e280.78\u0026thinsp;\u0026plusmn;\u0026thinsp;100.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e243.58\u0026thinsp;\u0026plusmn;\u0026thinsp;78.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss(ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e600.67\u0026thinsp;\u0026plusmn;\u0026thinsp;450.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e325.32\u0026thinsp;\u0026plusmn;\u0026thinsp;220.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood transfusion (yes/no)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48/10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36/16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003etValue or χ\u0026sup2;Value;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eb\u003c/sup\u003eManual muscle test score(0\u0026ndash;5)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eLaboratory results from the two groups were compared, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.D-dimer9.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.79mg/l in DVT group and 2.99\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11mg/l in non-DVT group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). CPR was 41.98\u0026thinsp;\u0026plusmn;\u0026thinsp;40.08 mg/l in the DVT group and 20.15\u0026thinsp;\u0026plusmn;\u0026thinsp;15.04mg/l in the non-DVT group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). DVT group NEUT10.57\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25\u0026times;10^9 / l, non-DVT group NEUT 8.58\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u0026times;10^9/l, NEUT difference was significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). RDW was 13.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28% in the DVT group and 12.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09% in the non-DVT group, with a significant difference in RDW (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). FIB was significant in DVT group FIB3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57g/l and non-DVT group FIB3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32g/l (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In the DVT group, PT13.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25s,PT and non-DVT PT13.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82s(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).Similarly, hypoproteinemia was significantly between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no significant difference in HGB, PLT, TT and APTT between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of laboratory results between two groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDVT Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-DVT Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ea Test Statistics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-dimer(mg/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.99\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-7.939\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP(mg/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.98\u0026thinsp;\u0026plusmn;\u0026thinsp;40.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.15\u0026thinsp;\u0026plusmn;\u0026thinsp;15.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-3.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHGB(g/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114.72\u0026thinsp;\u0026plusmn;\u0026thinsp;23.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122.43\u0026thinsp;\u0026plusmn;\u0026thinsp;22.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNEUT(\u0026times;10^9/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.57\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.58\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT(\u0026times;10^9/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e177.28\u0026thinsp;\u0026plusmn;\u0026thinsp;94.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e187.75\u0026thinsp;\u0026plusmn;\u0026thinsp;83.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRDW(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFIB(g/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.19\u0026thinsp;\u0026plusmn;\u0026thinsp;7.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPTT(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.09\u0026thinsp;\u0026plusmn;\u0026thinsp;6.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003eb\u003c/sup\u003eHypoproteinemia(yes/no)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47/11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31/21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003etValue or χ\u0026sup2;Value\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eb\u003c/sup\u003eHypoproteinemia is defined as plasma albumin level of less than 35g/l or plasma total protein less than 60g/l\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eComparing the two TEG groups, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. R significant difference between DVT group 3.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83min and non-DVT group 4.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81min (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). K was significant for 1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79min in DVT and non-DVT in 1.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61min (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Angle was Angle67.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.73\u0026deg;. DVT and Angle64.84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.99\u0026deg;. Angle (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). MA difference for DVT 61.95\u0026thinsp;\u0026plusmn;\u0026thinsp;10.19mm and non-DVT MA58.16\u0026thinsp;\u0026plusmn;\u0026thinsp;6.79mm (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison the TEG of two groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDVT Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-DVT Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eTest Statistics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR(min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK(min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAngle (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e67.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e64.84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMA(mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e61.95\u0026thinsp;\u0026plusmn;\u0026thinsp;10.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.16\u0026thinsp;\u0026plusmn;\u0026thinsp;6.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003etValue\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate Analysis of Postoperative DVT\u003c/h2\u003e \u003cp\u003eBinary logistic regression analysis of coronary heart disease, muscle strength of Lower extremity,duration of bed, operation time, D-dimer, CPR, NEUT, RDW, FIB, PT, Hypoproteinemia, R, K, Angle, MA was performed to explore the risk factors of DVT. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.The results show that D-dimer (OR,1.392;95%CI 1.020\u0026ndash;1.899;P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), Lower extremity (OR,10.051;95%CI 1.509\u0026ndash;20.345; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), Duration of bed (OR, 1.586; 95%CI 1.144-2.200; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), MA (OR,1.307; 95%CI 1.009\u0026ndash;1.695; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were independent risk factors for postoperative DVT in patients with traumatic spinal fractures combined with SCI.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis of risk factors for DVT\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR isk factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWald\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExp(β)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-dimer(mg/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.020\u0026ndash;1.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower extremity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.509\u0026ndash;20.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of bed (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.144-2.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMA(mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.009\u0026ndash;1.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eROC Analysis of Different Risk Factors\u003c/h2\u003e \u003cp\u003eWe used ROC analysis to determine the diagnostic value of different risk factors in postoperative DVT. The ROC curves for the four risk factors are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The AUC values indicate the diagnostic value of the predictors. D-dimer had the highest diagnostic value (AUC\u0026thinsp;=\u0026thinsp;0.883). The AUC values for Lower extremity, Duration of bed, and MA were 0.731,0.75, and 0.625, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). For The diagnostic cut-off value was determined by the Youden index.The diagnostic cut-off value for D-dimer was 5.065 mg/L, with sensitivity of 81% and specificity of 82.7%. Other diagnostic cut-off value lower extremity\u0026thinsp;\u0026lt;\u0026thinsp;3,duration of bed\u0026thinsp;\u0026gt;\u0026thinsp;12.5 days, MA\u0026thinsp;\u0026gt;\u0026thinsp;66.25mm.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe ROC results of different factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eCut-off value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSensitivity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecificity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-dimer(mg/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.821\u0026ndash;0.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower extremity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.634\u0026ndash;0.828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of bed (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.653\u0026ndash;0.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMA(mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.625\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.653\u0026ndash;0.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003eThe cut-off points of scores were determined by the Youden index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur retrospective findings indicate that despite chemical and mechanical prevention of DVT, the risk of postoperative DVT in traumatic spinal fractures was high (52.7%), 7 (6.4%) proximal thrombus and 51 distal thrombus (46.4%). None of the patients developed pulmonary embolism or epidural hematoma. D-dimer,lower extremity, duration of bed and MA were independent risk factors for developing DVT. We also found that D-dimer had the highest diagnostic value among the four factors.\u003c/p\u003e \u003cp\u003eDVT and PE, collectively called venous thromboembolism syndrome, is one of the common complications after spinal fracture and spinal cord injury.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e According to Virchow's triad, the three factors contributing to thrombosis are a hypercoagulable state of blood, endothelial injury of the vascular wall, and blood flow stasis.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Patients with SCI have motor and sensory dysfunction below the injury plane and a loss of muscle strength in both lower limbs. Some patients have complete spinal cord injury, which will seriously affect the sympathetic control of cardiac function, leading to the reduction of myocardial contractility, reduced venous blood supply of the lower limbs, reduced effective blood volume, increased blood viscosity, and hypercoagulable blood.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Patients with spinal fracture need to brake in bed, coupled with the lower limb motor dysfunction caused by spinal cord injury factors, weakened the function of lower limb muscle pump, slow venous blood reflux, blood stasis, easy to form a hypercoagulation state of blood, damaged vascular endothelium, platelet hyperfunction, which promotes the occurrence of DVT.\u003csup\u003e\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e–\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003eSome studies have reported that the incidence of spinal cord injury is about 10.3% -62.5%. We believe that the incidence is related to the detection method and time of detection. We studied 110 patients with surgical treatment for spinal cord injury, and the incidence of DVT was 52.7%.\u003c/p\u003e \u003cp\u003eIn our study, age, hypertension, diabetes, and smoke were not found to be independent risk factors for postoperative DVT in SCI patients, which is consistent with the conclusions of some scholars.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e It was also found that coronary heart disease may affect the occurrence of DVT. This may be because such patients are older and have poor vascular elasticity, but combined coronary heart disease is not an independent risk factor for DVT.Coagulation indicators,HGB,albumin,and inflammation indicators in laboratory tests are not independent risk factors for DVT formation.\u003c/p\u003e \u003cp\u003eIn our study, D-dimer \u0026gt; 5.065 mg/L on the first postoperative day was a risk factor for DVT after SCI. D-dimer is mainly a specific degradation product generated by the hydrolysis of fibrin monomer after cross-linking by activation factor, indicating a hypercoagulable state complicated by fibrinolysis. D-dimer is an important test for DVT diagnosis, with high negative predictive value and sensitivity, but its specificity is low because D-dimer levels can also increase in postoperative, infection, cancer, trauma, and other conditions.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003eAlthough affected by many factors, the D-dimer is still considered the most powerful indicator of venous thromboembolic events.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003eSurgical procedures increase D-dimer levels, and changes are more pronounced in patients with DVT.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Lv et al\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e studied 175 cervical fractures with spinal cord injuries found D-dimer \u0026gt; 1.02mg/L on admission as an independent risk factor for admission of DVT in SCI patients, with sensitivity 84.21% and specificity 78.10%. Masuda et al,\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e using a prospective study of 211 patients with SCI, showed that 22 patients (10.4%) developed DVT. D-dimer could be used to predict the likelihood of DVT in acute cervical fracture with SCI. The optimal screening time was 2 weeks after injury, and the optimal threshold level of D-dimer for DVT 16µg/dL.On the first postoperative day, our D-dimer \u0026gt; 5.065mg/L had the highest diagnostic value (AUC = 0.883), with a sensitivity of 81% and a specificity of 82.7%. Our study only included the discussion of D-dimer on the first postoperative day,and factors such as the stimulation of surgery,the stimulation of trauma,the release of inflammatory mediators,anesthesia, intraoperative bleeding, and postoperative rehydration may all lead to the elevation of D-dimer.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur study showed that lower extremity \u0026lt; 3 is one of the independent risk factors for postoperative DVT in SCI patients. Decreased lower extremity causes reduced muscle pump function, reduced venous blood return in the lower limbs, blood stasis, and a higher propensity for DVT.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003eWang et al\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e research the predictors of preoperative deep vein thrombosis in 429 patients with high-energy injury suggested that lower extremity \u0026lt; 3 was an independent predictor of preoperative DVT,and that reduced lower extremity caused an 8.257-fold increased risk of preoperative DVT. Some scholars have studied the ossification of the posterior longitudinal ligament with acute spinal cord injury, showing that the impairment of lower limb motor function is a risk factor for DVT in the lower limbs.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Imyro et al\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e research 698 lumbar degenerative surgeries found that preoperativelower extremity \u0026lt; 3 was closely associated with the occurrence of DVT, which was consistent with our results. \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003ePatients with spinal cord injury with dinnervation, complete loss of movement and sensation below the plane of injury, incomplete SCI patients with lower limb motor dysfunction.Our study patients with lower extremity \u0026lt; 3, the risk of postoperative DVT increased 10-fold.Therefore, patients admitted with lower extremity \u0026lt; 3 should take active measures to prevent DVT and reduce its incidence.\u003c/p\u003e \u003cp\u003eProlonged duration of bed and reduced activity of the lower limbs can affect venous blood flow in the lower limbs, leading to less reflux, slower blood flow, blood stasis, and an increased likelihood of forming a hypercoagulable state, which can lead to DVT.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003eWang et al\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e studied the risk factors for postoperative DVT in patients with thoracolumbar fractures due to high-energy injury under LMWH prevention, suggesting that time in bed stay \u0026gt; 12 days was an independent risk factor for postoperative DVT. In our study, the duration of bed was 14.28 ± 2.76 days in the DVT group and 10.96 ± 3.75 days in the non-DVT group. Duration of bed \u0026gt; 12.5 days in SCI patients was an independent risk factor for postoperative DVT. After spinal fracture, the spine lacks stability, and patients with long-term bed from admission to surgery, especially those partially paralyzed with complete loss of lower limb motor function, are more prone to blood stasis and have a higher incidence of DVT in the lower limbs. Therefore, patients with SCI who retain lower limb motor function should get out of bed as soon as possible for functional exercise to prevent DVT.\u003c/p\u003e \u003cp\u003eThe MA value in TEG refers to the maximum blood clot strength and represents the maximum amplitude of the marker curve. This value reflects the maximum mechanical strength and stability of the blood clot during coagulation. The blood clot is composed of fibrin and platelets, and the amount, strength, and condensation of these components affect the MA value. However, the contribution of platelets to the MA value is larger than that of fibrinogen.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Liu et al\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e in elderly fracture patients found that increased MA values in TEG suggested hypercoagulable blood. In our study, we found that the MA value was 61.95 ± 10.19 mm in the DVT group and 58.16 ± 6.79 mm in the non-DVT group. The best cut-off value of MA for predicting the formation of DVT was 66.25 mm.\u003c/p\u003e \u003cp\u003eOur current study has some limitations. First, this was a retrospective study with selection bias. Secondly, our sample size was small, and some influencing factors were not included in the study. Third, we only discussed the impact of D-dimer measurements on the first postoperative day; multiple tests before operation and on postoperative days 1, 3, and 5 should be included in future studies. Finally, future prospective studies with larger samples and multiple centers are needed to confirm our results.\u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003ePostoperative D-dimer\u0026gt;5.065mg/l, lower extremity \u0026lt; 3, duration of bed, MA value are independent risk factors for postoperative lower limb DVT in SCI patients, with D-dimer having the highest diagnostic value.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDVT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDeep vein thrombosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSpinal Cord Injury\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReceiver operating characteristic\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRDW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRed blood cell distribution width\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHypoproteinemia\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePlasma albumin level of less than 35g/l or plasma total protein less than 60g/l\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAUC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArea under the curve\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMWH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow molecular weight heparin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of Conflicting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e \u003ch2\u003eEthical Approval\u003c/h2\u003e \u003cp\u003e The Ethics Committee of Yichang Central People's Hospital approved this study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eD.Y. :Formal analysis, Writing - review \u0026amp; editing. SW.C.: Data curation, Writing-original draft.C. Z.:Software,Validation. HD. C.: Conceptualization, Methodology, Software,Visualization.All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eManga S, Younes ABH, Dioum M, et al. Deep venous thrombosis of lower limbs: Prevalence, risk factors and treatment in Semi -urban areas in Senegal. J Open J Intern Med. 2021;11(4):194\u0026ndash;200.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain NB, Ayers GD, Peterson EN, et al. Traumatic spinal cord injury in the United States,1993\u0026ndash;2012. JAMA. 2015;313(22):2236\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAito S, Pieri A, D'Andrea M, et al. Primary prevention of deep venous thrombosis and pulmonary embolism in acute spinal cord injured patients. Spinal Cord. 2002;40(6):300\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei B, Zhou H, Liu G et al. Risk factors for venous thromboembolism in patients with spinal cord injury: A systematic review and meta -. Anal J J Spinal Cord Med. 2021 (5):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang H, Pei H, Ding W, et al. Risk factors of postoperative deep vein thrombosis (DVT) under low molecular weight heparin (LMWH) prophylaxis in patients with thoracolumbar fractures caused by high-energy injuries. J Thromb Thrombolysis. 2021;51(2):397\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSumislawski JJ, Kornblith LZ, Conroy AS, et al. Dynamic coagulability after injury: Is delaying venous thromboembolism chemoprophylaxis worth the wait? J Trauma Acute Care Surg. 2018;85(5):907\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNavarrete S, Solar C, Tapia R, et al. Pathophysiology of deep vein thrombosis. Clin Exp Med. 2023;23(3):645\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForan SJ, Taran S, Singh JM, et al. Timing of tracheostomy in acute traumatic spinal cord injury: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2022;92(1):223\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatsios C, Griffith L, Spinella P, et al. Red blood cell transfusion and increased length of storage are not associated with deep vein thrombosis in medical and surgical critically ill patients: a prospective observational cohort study. Crit Care. 2011;15(6):R263.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFischer CR, Wang E, Steinmetz L, et al. Prevalence of Risk Factors for Hospital-Acquired Venous Thromboembolism in Neurosurgery and Orthopedic Spine Surgery Patients. J Spine Surg. 2020;14(1):79\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIchikawa N, Kumagai G, Wada K, et al. High incidence of venous thromboembolism after acute cervical spinal cord injury in patients with ossification of the posterior longitudinal ligament. J Spinal Cord Med. 2022;45(1):100\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShang Z, Wanyan P, Zhang B, et al. Incidence and risk factors of deep vein thrombosis in patients with spinal cord injury: a systematic review with meta-analysis. Front Cardiovasc Med. 2023;10:1153432.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePiran S, Schulman S. Incidence and risk factors for venous thromboembolism in patients with acute spinal cord injury:A retrospective study. Thromb Res. 2016;147:97\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJazayeri SB, Maroufi SF, Mohammadi E, et al. Incidence of traumatic spinal cord injury worldwide: A systematic review, data integration, and update. World Neurosurg X. 2023;18:100171.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBengoa F, Vicencio G, Schweitzer D, et al. High prevalence of deep vein thrombosis in elderly hip fracture patients with delayed hospital admission. J Eur J trauma Emerg surgery: official publication Eur Trauma Soc. 2020;46(4):913\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamada K, Suda K, Matsumoto Harmon S, et al. Rapidly progressive cervical myelopathy had a high risk of developing deep venous thrombosis: a prospective observational study in 289 cases with degenerative cervical spine disease. Spinal Cord. 2019;57(1):58\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamli NN, Iberahim S, Mohd Noor NH, et al. Haemostasis and Inflammatory Parameters as Potential Diagnostic Biomarkers for VTE in Trauma-Immobilized Patients. 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Med (Baltim). 2016;95(24):e3934.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"spinal cord injury, deep vein thrombosis, spinal fracture, risk factor, D-dimer","lastPublishedDoi":"10.21203/rs.3.rs-4497481/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4497481/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe purpose of this study is to investigate the risk factors for postoperative DVT in patients with traumatic spinal fractures complicated with Spinal Cord Injury(SCI). We conducted a retrospective analysis of 110 patients with traumatic spinal fractures and SCI admitted to our hospital from March 2021 to April 2024. DVT was diagnosed usingr ultrasound.Patient history, general data, surgical data, laboratory tests, and thromboelastogram (TEG) results were collected. The patients were divided into a DVT group and a non-DVT group according to the results of color ultrasound one week after surgery. The risk factors and diagnostic value were analyzed using binary logistic regression and receiver operating characteristic (ROC) curves in both univariate and multivariate analyses. The incidence of postoperative DVT was 52.7% (58 / 110). Seven patients (6.4%) had proximal thrombus, and 51 patients had distal thrombus (46.4%). Multivariate and ROC analysis results showed that D-dimer, lower extremity, duration of bed, and MA values were independent risk factors for DVT in SCI, with D-dimer having the highest diagnostic value (AUC = 0.883). The AUC values for lower extremity, duration of bed, and MA were 0.731, 0.750, and 0.625. In conclusion, Postoperative D-dimer\u0026gt;5.065mg/l, lower extremity\u0026lt; 3, duration of bed, and MA value are independent risk factors for postoperative DVT in SCI patients, D-dimer having the highest diagnostic value.\u003c/p\u003e","manuscriptTitle":"Analysis of Risk Factors for Postoperative Deep Vein Thrombosis in Traumatic Spinal Fracture Complicated with Spinal Cord Injury","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-20 18:45:56","doi":"10.21203/rs.3.rs-4497481/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c9a62acf-68fa-4dc8-8634-dfc79a56551f","owner":[],"postedDate":"June 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-21T23:23:51+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-20 18:45:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4497481","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4497481","identity":"rs-4497481","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}