Abstract
The objective was to study the risk factors of venous thrombosis after ankle fracture with type 2 diabetes mellitus surgery using a tourniquet and to assess the effect of ischemic preconditioning and metformin combination therapy in preventing thrombosis. One hundred eighty patients with ankle fractures combined with type 2 diabetes mellitus treated with lower extremity tourniquet surgery between January 2020 and December 2023 were analyzed. Based on postoperative color Doppler ultrasound of both lower extremities, the patients were divided into thrombus-positive and negative groups. Multifactorial logistic regression analysis was utilized to determine the high-risk factors for venous thrombosis and construct a prediction model. There were 64 cases in the positive group and 116 cases in the negative group. The differences between the 2 groups in gender, age, fracture site, preoperative glycosylated hemoglobin, thromboelastography parameters, duration of surgery, D-dimer level at 1-week postoperatively, and thromboelastography K, α, and MA values were not statistically significant (P > .05); however, there was no statistically significant difference in the preoperative D-dimer level, tourniquet duration, bleeding volume, thromboelastography R-value at 1-week postoperatively, and ischemic preconditioning in combination with metformin treatment patient There was a significant difference in the proportion (P < .05). Multifactorial logistic regression analysis showed that preoperative high D-dimer, prolonged tourniquet application, massive bleeding, and increased thromboelastography R-value at 1-week postoperatively were independent risk factors, and ischemic preconditioning combined with metformin was a protective factor. Preoperative high D-dimer, prolonged tourniquet application, massive bleeding, and increased thromboelastography R-value at 1-week postoperatively were independent risk factors for postoperative venous thrombosis in patients with ankle fracture with type 2 diabetes mellitus and ischemic preconditioning combined with metformin treatment was a protective measure, and the prediction model is valuable in guiding clinical thrombosis risk assessment.