血栓预防性治疗在踝部骨折术后的作用探讨

The Efficacy of Thromboprophylaxis after Surgical Treatment of Ankle Fractures

目的探讨危险因素与血栓预防性治疗对血栓栓塞事件发生率的影响。方法对328名踝部骨折手术患者进行回顾性研究。考虑血栓栓塞事件的危险因素:肿瘤、激素或口服避孕药、怀孕、恶血质、深静脉栓塞或肺栓塞病史、吸烟史、肥胖(BMI>35.0 Kg/m2)、血脂异常、血管粥样硬化疾病、瘫痪等。53名病人(16.15%)接受了血栓预防性治疗(低分子肝素或华法林)。统计分析危险因素与血栓预防性治疗对血栓栓塞事件发生率的影响。结果血栓栓塞发生比例为2.74%(9例),其中深静脉栓塞2.13%(7例)、非致命性肺栓塞0.61%(2例)。148例患者(45.1%)至少存在一种危险因素,血栓栓塞事件发生率的相对危险因子为0.66。危险因素和血栓预防性治疗对血栓栓塞事件的发生率无统计学关联。结论踝部骨折治疗后不建议给予患者血栓预防性治疗。

Objective To explore the effects of risk factors and preventive treatments of thrombus on the incidence of thromboembolic events. Methods From January 2008 to March 2013, 328 patients underwent surgical treatment ankle fracture were conducted in this retrospective study. Charts were reviewed to identify risk factors, such as tumor, hormone use, pregnancy, blood dyscrasia, history of thromboembolic events, smoking history, obesity, dyslipidosis, atherosclerotic vascular disease, paralysis, etc. Fifty-three patients （16.15%） were treated with thromboprophylaxis （low-molecular-weight heparin or warfarin）. The effects of risk factors and preventive treatments of thrombus on the incidence of thromboembolic events were statistical analysed. Results The incidence of thromboembolic events was 2.74% （9 cases）, with 2.13% （7 cases） involving deep venous thrombosis and 0.61% （2 cases） involving nonfatal pulmonary embolism. One hundred and forty eight patients （45.1%） had one or more risk factors. Patients with one or more risk factors had a greater risk of thromboembolic events （relative risk 0.66）. No significant correlation could be identified between the occurrence of thromboembolic events and risk factors or preventive treatments of thrombus. Conclusion Thromboprophylaxis should not be suggested after the surgical treatment of ankle fractures.