[1]楚翔宇,程文俊,王俊文,等.老年股骨颈骨折全髋关节置换术围手术期下肢深静脉血栓形成的特点[J].中华老年骨科与康复电子杂志,2018,(02):75-79.[doi:10.3877/cma.j.issn.2096-0263.2018.02.003]
 Chu Xiangyu,Cheng Wenjun,Wang Junwen,et al.Features of deep venous thrombosis in aged patients with femoral neck fracture during the perioperative period[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(02):75-79.[doi:10.3877/cma.j.issn.2096-0263.2018.02.003]
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老年股骨颈骨折全髋关节置换术围手术期下肢深静脉血栓形成的特点()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2018年02期
页码:
75-79
栏目:
深静脉血栓
出版日期:
2018-03-31

文章信息/Info

Title:
Features of deep venous thrombosis in aged patients with femoral neck fracture during the perioperative period
作者:
楚翔宇程文俊王俊文左伟焦竞勘武生
430033 武汉,华中科技大学同济医学院附属普爱医院骨科
Author(s):
Chu Xiangyu Cheng Wenjun Wang Junwen Zuo Wei Jiao Jing Kan Wusheng.
Pu’ai Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
关键词:
静脉血栓形成 关节成形术置换 股骨颈骨折 围手术期
Keywords:
Venous thrombosis Arthroplasty replacement hip Femoral neck fractures Perioperative period
DOI:
10.3877/cma.j.issn.2096-0263.2018.02.003
文献标志码:
A
摘要:
目的 探讨老年股骨颈骨折行人工全髋关节置换术及规范化预防性抗凝治疗下围手术期下肢深静脉血栓形成的特点。方法 回顾性分析2015年1月~2017年6月华中科技大学同济医学院附属普爱医院骨科行人工全髋关节置换的老年患者363例,年龄(66±5)岁,男性114例(31.4%),女性249例(68.6%)。将患者分为股骨颈骨折组(n=187)和非股骨颈骨折组(n=176)。按照《中国骨科大手术静脉血栓栓塞症预防指南》进行规范化血栓预防,对围手术期出现下肢深静脉血栓的患者进行回顾性分析,对比两组患者围手术期深静脉血栓形成的特点。结果 骨折组患者中8例出现下肢深静脉血栓,其中2例并发肺栓塞;非骨折组中6例出现下肢深静脉血栓,其中1例并发肺栓塞,差异无统计学意义(c2=0.185,P>0.05)。骨折组下肢深静脉血栓5例发生于术前,3例发生于术后;非骨折组6例患者均发生于术后,两组比较差异有统计学意义(P<0.05)。结论 老年股骨颈骨折全髋关节置换患者术前和术后均易形成下肢深静脉血栓,对于这类特殊的群体,术前血栓防治也应引起足够的重视。
Abstract:
Objective To investigate the formation characteristics of deep venous thrombosis (DVT) in aged patients with femoral neck fracture who underwent total hip arthroplasty (THA) and treated with standard prophylatic anticoagulant therapy. Methods A retrospective study was performed in 363 aged patients 66±5 years cases underwent unilateral THA from January 2015 to June 2017. There were 114 male patients (31.4%) and 249 female patients (68.6%). Patients were divided into femoral neck fracture (n=187) and non-fracture (n=176) groups. Two groups were strictly complied "China’s major orthopedic surgery venous thromboembolism prevention guidelines" for thromboprophylaxis. Retrospectively analyzed and compared patients with DVT occurred during the perioperative period. Results There were 8 patients (2 patients occurred pulmonary embolism) with DVT in fracture group and 6 patients (1 patient occurred pulmonary embolism) with DVT in non-fracture group. Differences had no statistical significance (c2=0.185,P>0.05). In fracture group, 5 patients occurred DVT before surgery and 3 after surgery. Meanwhile all 6 patients occurred DVT after surgery in the non-fracture group, differences of DVT distribution between two groups was statistically significant (P<0.05). Conclusions DVT was easy formed before and after surgery in elderly femoral neck fracture patients with THA. For these specific groups, prevention of DVT before operation is the priority.

参考文献/References:

1 钱文伟, 翁习生, 常晓, 等. 人工髋关节置换后深静脉血栓形成影响因素的回顾分析 [J]. 中国组织工程研究, 2012, 16(4): 622-625.
2 尹知训, 余楠生, 卢伟杰, 等. 初始全髋关节置换静脉血栓栓塞症预防的临床研究 [J]. 中国骨与关节外科, 2013, 6(Suppl 1): 05-011.
3 Caprini JA. Risk assessment as a guide to thrombosis prophylaxis [J]. Curr Opin Pulm Med, 2010, 16(5): 448-452.
4 中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南 [J]. 中华骨科杂志, 2009, 29(6): 602-604.
5 Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [J]. Chest, 2012, 141(2 Suppl): e278S-e325S.
6 Wells PS, Anderson DR, Rodger M, et al. Evaluation of D-dimmer in the diagnosis of suspected deep-vein thrombosis [J]. N Engl J Med, 2003, 349(13): 1227-1235.
7 陆慧杰, 庄汝杰, 陈之青. 利伐沙班对比依诺肝素预防骨科大手术后深静脉血栓形成的疗效与安全性评价 [J]. 中国临床药理学杂志, 2015, 31(9): 693-695.
8 吕厚山, 徐斌. 人工关节置换术后下肢深静脉血栓形成 [J]. 中华骨科杂志, 1999, 19(3): 155.
9 邱贵兴, 杨庆铭, 余楠生, 等. 低分子肝素预防髋、膝关节手术后下肢深静脉血栓形成的多中心研究 [J]. 中华骨科杂志, 2006, 26(12): 819-822.
10 陈东峰, 余楠生, 卢伟杰, 等. 低分子肝素联合间歇充气加压预防人工关节置换术后下肢深静脉血栓形成 [J]. 中华骨科杂志, 2006, 26(12): 823-826.
11 Heit JA, O’fallon WM, Petterson TM, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study [J]. Arch Intern Med, 2002, 162(11): 1245-1248.
12 Anderson FA, Spencer FA. Risk factors for venous thromboembolism [J]. Circulation, 2003, 107(23 Suppl 1): I9-16.
13 Goel DP, Buckley R, Devries G, et al. Prophylaxis of deep-vein thrombosis in fractures below the knee: a prospective randomised controlled trial [J]. J Bone Joint Surg Br, 2009, 91(3): 388-394.
14 孙葵葵, 王辰, 古力夏提, 等. 深静脉血栓形成的危险因素及临床分析 [J]. 中华结核和呼吸杂志, 2004, 27(11): 727-730.
15 Geerts WH, Code KI, Jay RM, et al. A prospective study of venous thromboembolism after major trauma [J]. N Engl J Med, 1994, 331(24): 1601-1606.
16 Kümpel P. Screening by the nurses. The danger of thrombosis in the hospital [J]. Pflege Z, 1995, 48(5): 274-278.

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备注/Memo

备注/Memo:
基金项目:湖北省科技厅课题(2011BCB028)
更新日期/Last Update: 2018-03-27