急性股骨干骨折患者深静脉血栓的诊断及治疗

Diagnosis and treatment of deep venous thrombosis in patients with acute fracture of shaft of femur

目的探讨诊断治疗急性股骨干骨折患者深静脉血栓(DVT)的方法。方法回顾性分析因急性股骨干骨折来我院住院治疗的148例患者的临床资料,患者入院后监测D-二聚体。对于可疑DVT患者,均首选下肢彩色多普勒超声,必要时行静脉造影以明确诊断。全部患者均接受物理治疗和预防性抗凝治疗。结果共诊断27例DVT,其中中心型或混合型18例,周围型9例。入院时患者总体的D-二聚体值均升高。经预防性抗凝之后,非DVT的患者的D-二聚体值呈逐渐下降趋势;而DVT患者在监测的第3天和第5天D-二聚体仍维持在高水平状态。周围型DVT患者术后抗凝2周,中心型或混合型DVT患者骨科手术前放置了临时腔静脉滤器,术后继续抗凝到半年,在整个研究期间和随访期间,均未有肺栓塞(PE)报告。结论骨折患者D-二聚体监测的特异性较差,应该根据其动态变化,结合患者的症状体征综合考虑DVT可能。

Objective To explore an efficient diagnosis and treatment strategy for deep venous thrombosis （DVT） in patients with acute fracture of shaft of femur. Methods Summarizing data from 148 hospitalized patients with acute fracture of shaft of femur. Serum D-dimer was monitored at day 1,3, 5, 7, 14 and 21. Doppler ultrasonography and if necessary, venography was used to diagnose DVT. Physical therapy and preventive anti-coagulation were administered to all patients. Results 27 cases of DVT were diagnosed. Among them, 18 cases were central or mixed DVT and 9 cases were peripheral DVT. Serum D-dimer elevation was found in all patients at the hospital admission. In patients without DVT, D-dimer concentration gradually decreased during hospitalization. Contrarily, D-dimer value at day 3 and day 5 increased in patients diagnosed of DVT. Anti-coagulation was prolonged to two weeks after orthopedic operation in patients with peripheral DVT. While temporary vena cava filters were implanted into patients with central or mixed DVT and oral anti-coagulant was prescribed until six months after orthopedic operation. No pulmonary embolism （PE） was reported in this study. Conclusion Due to reduced specificity of D-dimer assay in fractural patients, DVT may be diagnosed by actively monitoring D-dimer in conjugation with evaluation of clinical signs and symptoms.