髋部周围骨折手术预防深静脉血栓形成的几个基本问题——兼谈《中国骨科大手术静脉血栓栓塞症预防指南》

Issues about deep vein thromboembolism prevention in operations on fractures around the hip and discussion on “Chinese guide for venous thromboembolism prevention in major orthopedic surgeries”

《中国骨科大手术静脉血栓栓塞症预防指南》已实施三年多,本文就其有关髋部周围骨折手术预防深静脉血栓形成(DVT)提出看法:①髋部周围骨折与髋部骨折含义有所不同,两者不宜混淆;②引用的国人临床数据有违原意,应注重循证医学的证据质量;③药物预防分为伤后12 h内开始手术者脱离临床实际;④药物利伐沙班表述为"暂无适应证"欠妥。并对当前临床指南谈点感悟。

The ＂Chinese guide for venous thromboembolism prevention in major orthopedic surgeries＂ has been put into practice tbr more than three years. The article presented some views about deep vein thromboembolism （DVT） prevention in operations on fractures around the hip： ①around-the-hip fracture and hip fracture are two different concepts, which should not be confused; ②quoting domestic data goes against to the original intention, and quality of the evidence of evidence-based medicine should be considered; ③ the drug prevention time, which is at the beginning of operation within 12 h after trauma, deviates the clinical practice： ③ it seems improper to say ＂no indication now＂ for rivaroxaban in the guide. Finally, 1 would like to talk some of my own understandings about the current clinical guides.