摘要
目的探讨抗凝时机对老年髋部骨折患者围手术期深静脉血栓形成(DVT)发生率的影响。方法回顾性分析2017年7月至2018年12月期间西安交通大学医学院附属红会医院创伤骨科下肢病区收治的179例老年髋部骨折患者资料。男78例,女101例;年龄为62~91岁,平均79.5岁;股骨颈骨折79例,股骨转子间骨折100例;采用内固定治疗109例,髋关节置换70例。根据患者受伤后开始抗凝的时间不同分为3组:抗凝1组74例,受伤后<24 h开始抗凝;抗凝2组36例,受伤后24~48 h开始抗凝;抗凝3组69例,受伤后>48 h开始抗凝。所有患者均于术前12 h停药,术后8~12 h继续使用药物抗凝。比较3组患者围手术期DVT的发生率。结果3组患者术前一般资料的比较差异均无统计学意义(P>0.05),具有可比性。84例患者围手术期发生DVT,发生率为46.9%(84/179)。抗凝1组、抗凝2组及抗凝3组患者围手术期DVT的发生率分别为27.0%(20/74)、47.2%(17/36)、68.1%(47/69),差异有统计学意义(χ^(2)=24.206,P<0.001),3组之间两两比较差异均有统计学意义(P<0.05)。结论对于老年髋部骨折患者,受伤后越早开始抗凝,围手术期DVT的发生率越低。老年髋部骨折患者受伤后早期正规进行预防性抗凝治疗,可有效降低围手术期DVT的发生率。
Objective To study the influence of anticoagulation timing on incidence of perioperative deep venous thrombosis(DVT)in elderly patients with hip fracture.Methods A retrospective analysis was made of the 179 elderly patients with hip fracture who had been admitted to Department of Orthopedics and Traumaology,Hong-Hui Hospital from July 2017 to December 2018.They were 78 males and 101 females,aged from 62 to 91 years(mean,79.5 years).There were 79 femoral neck fractures and 100 intertrochanteric fractures,109 of which were treated by internal fixation and 70 by hip replacement.The patients were divided into 3 groups depending on the timing of anticoagulation after injury.In group 1 of 74 cases,anticoagulation started<24 h after injury;in group 2 of 36 cases,anticoagulation started 24 to 48 h after injury;in group 3 of 69 cases,anticoagulation started>48 h after injury.Anticoagulation continued until 12 h before surgery in all patients but was resumed 8 to 12 h after surgery.The 3 groups were compared in incidence of perioperative DVT.Results The 3 groups were comparable due to insignificant differences between them in their pre-operative general data(P>0.05).DVT occurred perioperatively in 84 patients,yielding an incidence of 46.9%(84/179).The incidences of perioperative DVT were 27.0%(20/74),47.2%(17/36)and 68.1%(47/69)in groups 1,2 and 3,respectively,showing significant differences(χ^(2)=24.206,P<0.001),between any 2 groups(P<0.05).Conclusion Since the earlier anticoagulation starts after injury the lower incidence of perioperative DVT in elderly patients with hip fracture,early standardized prophylactic anticoagulation after injury can effectively reduce incidence of perioperative DVT.
作者
张诚诚
路遥
任程
孙亮
王谦
马腾
李明
李忠
张堃
张聪明
许毅博
黄强
段宁
刘宏亮
薛汉中
林华
杨娜
戚鸿飞
崔玉
Zhang Chengcheng;Lu Yao;Ren Cheng;Sun Liang;Wang Qian;Ma Teng;Li Ming;Li Zhong;Zhang Kun;Zhang Congming;Xu Yibo;Huang Qiang;Duan Ning;Liu Hongliang;Xue Hanzhong;Lin Hua;Yang Na;Qi Hongfei;Cui Yu(Department of Orthopaedics and Traumaology,Hong-Hui Hospital,Xi'an Jiaotong University College of Medicine,Xi'an 710054,China;Medical School of Yan'an University,Yanan 716000,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2021年第12期1071-1075,共5页
Chinese Journal of Orthopaedic Trauma
基金
陕西省重点研发计划-社会发展领域(2017ZDXM-SF-009)。
