低分子肝素预防老年人股骨转子间骨折手术后深静脉血栓形成

Evaluation of safety and effectiveness of low-molecular-weight heparin in the prevention of deep venous thrombosis in geriatric patients undergoing intertrochanteric femoral fractures operation

目的探讨老年人股骨转子间骨折围手术期下肢深静脉血栓（DVT）的发生率及应用低分子肝素预防DVT的有效性和安全性。方法对2005年7月至2011年5月收治的65岁以上的179例股骨转子间骨折患者进行对照研究，完全随机分成2组，观察组106例患者腹壁皮下注射低分子肝素进行抗凝预防，对照组73例不采用任何预防方法。对比2组失血量及术后下肢DVT发生率的情况。结果观察组与对照组失血量差异无统计学意义[观察组：（565±155）d；对照组：（560±170）ml，P〉0．05]。2组患者术后下肢DVT发生率差异有统计学意义[观察组：12．3％（13／106）；对照组：32．9％（24／60），P〈0．05]。结论低分子肝素可以有效预防老年人股骨转子间骨折术后DVT的发生，同时对于已发生的DVT有良好的治疗效果。

Objective To find out the postoperative deep venous thrombosis （DVT） incidence in geriatric patients undergoing intertrochanteric femoral fractures surgery, and to evaluate the effectiveness and safety of low- molecular-weight heparin in the prevention of DVT. Methods From July 2005 to May 2011,179 geriatric patients with intertrochanteric femoral fractures treated with operation were divided into prophylaxis group and control group randomly. 106 in the observation group and 73 in the control group. The observation group comprised 48 males and 58 females. The male patients included 19 cases proximal femoral nail （PFN）, and 29 cases dynamic hip screw （DHS）. The female patients included 21 cases PFN, and 37 cases DHS. In the control group, 30 cases were male, 43 cases were femal. The male patients included 11 cases PFN, and 19 cases DHS. The female patients included 12 cases PFN, and 31 cases DHS. Results There were no significant changes between intra and postoperative bleed- ing in all the patients. In the observation group, 13 patients had a DVT rate of 12.6% （13/106）. In the control group, DYT occurred in 24 cases with an incidence of 32.9% （？A/73）. A significant difference in DYT incidence was found between these two groups. Conclusion Low-molecular-weight heparin can effectively reduce the inci- dence of DVT after intertrochanteric femoral fractures operation and has a good result in treating DVT.