Significance of preoperative screening of deep vein thrombosis on the prevention from pulmonary embolism

Objective:To Explore the significance of preoperative screening of deep vein thrombosis(DVT) on the prevention from pulmonary embolism(PE) with color Doppler flow imaging (CDFI) in patients of lower limb fractures. Methods:A total of 2 000 patients with lower limb fractures were retrospectively analyzed from January to September in 2010. All the patients were scheduled to be operated. There were 1 140 males and 860 females,ranging in age from 18 to 94 years,with a mean of (54.78±21.45) years. Swollen limbs could be observed in all patients when admitted and traditional Chinese medicine therapies were given by both internal and external administrations. Selective internal or external fixations were scheduled 3 to 14 days after injured and the swell relieved. CDFI screenings for DVT were applied to all the patients one day before operations and clinical data,such as gender,age,fracture site and course of diseases,were analyzed. Results:Of all the 2 000 patients,128 patients had lower limbs DVTs(6.4%). Among all the DVT patients,52 patients had DVT within vena iliacas or femoral veins,20 patients had DVT within popliteal veins or vena crualis,56 patients had DVT within small muscular veins of legs. Thrombolytic therapies or inferior vena cava filters were taken to 72 patients with DVTs proximal to vena cruralises and thrombi disappeared in 20 cases. Inferior vena cava filters were placed in 17 patients. There were 28 patients with either failed thrombolytic or no filters placement. All above 65 patients were treated with fracture reduction,and other 7 patients were treated with conservative methods. Of all the operated patients,one patient had PE during operation and recovered after immediately rescue. Among 56 patients with DVT within small muscular veins of legs,51 patients were treated with reduction without other special treatment,and other 5 patients were treated with conservative methods. There was no relationship between DVT occurrence and gender. The youngest sufferer was 22 years old. DVT occurrences of patients over 41 years old were significantly higher than that of patients under 40 years old. Higher occurrences were also observed in patients with multiple fractures,fracture of femurs compared with those with tibia or fibula fractures. DVT was found as early as 3 days after injury in one case. The longer the time from injuries to operations,the higher the occurrences of DVTs. Conclusion:Routine CDFI screenings should be applied to traumatic fractured patients before operations no matter whether there are DVTs existing or not. That is very important for the prevention of fatal PE during both anesthesias and operations.