延迟手术的下肢长管状骨闭合性骨折患者凝血指标检测及临床意义

Clinical values and changes of coagulation parameters in delayed operation in patients with lower limbs long tubular bone fracture

目的通过观察延迟手术的下肢长管状骨闭合性骨折患者术前不同时期的凝血功能变化,来探讨这种变化对延迟手术后下肢深静脉血栓形成(DVT)的影响。方法36例在受伤5d后进行手术治疗的下肢长管状骨闭合性骨折患者,均未进行预防性药物抗凝治疗,分别于受伤后1d、3d、5d检查血浆部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶凝固时间(TT)、纤维蛋白原(Fib)和D-二聚体(D-D),以同期体检者为对照组。结果与对照组相比,骨折组第1天APTT、PT延长,第3天、第5天APTT、PT均缩短,差异均有统计学意义(t分别=-2.87、-3.14、2.22、2.64、4.74、6.72,P均<0.05);骨折组第1天、第3天、第5天的TT均延长,差异均有统计学意义(t分别=-4.00、-3.66、-9.67,P均<0.05);骨折组第1天、第3天、第5天的FIB和D-D含量升高,差异均有统计学意义(t分别=-9.12、-10.04、-4.15、-11.17、-22.88、-30.30,P均<0.05)。结论下肢长管状骨闭合性骨折受伤后出现先低凝后高凝的凝血功能变化,延迟手术需注意防止高凝导致的DVT等并发症的发生。

Objective To observe the changes of coagulation parameters in delayed operation in patients with lower limbs long tubular bone fracture before operation and discuss the influence of the changes to the occurrence of deep venous thrombosis. Method Thirty six patients with long tubular bone fracture in lower limbs were selected as test group. The time from fracture to operation exceeded 5 days. The fasting venous blood samples were taken on the 1st, 3rd and 5th day after fracture for measurement of the activated partial thromboplastin time （APTT）,prothrombin time （PT）, thrombin time （TT）, fibrinogen （Fib） and D-dimer concentration （D-D）. Results Compared with those in control group, in test group APTT and PT were higher significantly on the 1st day and shorted on the 3rd and 5th day （t=-2.87,-3.14,2.22,2.64,4.74,6.72, P〈0.05 ）. TT were extended in test group（ t=--4.00,-3.66,-9.67, P〈0.05 ）. Fib and D-D increased significantly on the lst,3rd and 5th day （t=-9.12,-10.04,-4.15,-11.17,-22.88,-30.30, P〈0.05）. Conclusions The coagulation decreased in the early stage but increased subsequently in patients with long tubular bone fracture in lower limbs. Prophylactic measures should be taken to prevent the occurrence of venous thrombosis when delayed surgery was considered.