股骨转子间骨折对老年患者凝血影响的研究

Impact of Intertrochanteric Fracture on Coagulation Function in Elder Patients

【目的】研究股骨转子间骨折对老年患者凝血功能的影响。【方法】选择2011年3月至2013年4月本院诊治的60岁以上股骨转子间骨折患者217例作为观察组；选择同期60岁以上健康查体者100例作为对照组，分别于不同时间点抽血，检测两组患者的血栓弹力图（TEG）、D-二聚体（DD）浓度等凝血指标。【结果】观察组各个时间点D-D与对照组比较，差异均有统计学意义（P〈0．05）。观察组TEG各项指标中凝血反应时间（R）、凝固时间（K）于骨折后d2和d7均较对照组低，差异有统计学意义（P〈0．05）；观察组R、Kd2与d7比较，差异有统计学意义（P〈0．05）。观察组骨折后d2及d7的α角、血栓最大幅度（MA）、凝血块强度（G）及凝血综合指数（CI）与对照组比较差异有统计学意义（P〈0．05），d2与d7比较，差异均有统计学意义（P〈0．01）。【结论】老年股骨转子间骨折患者的凝血功能在骨折后24h内增强，并随时间的延长继续高凝状态；应采取必要的措施加强术中管理，预防静脉血栓的形成。

[Objective] To explore the impact of intertrochanteric fracture on coagulation function in elder patients. [Methods] From March 201t to April 2013, a total of 217 elder patients aged over 60 years were selected as observation group and 100 healthy volunteers aged over 60 years during the same period as control group. The venous blood samples were collected at different timepoints. And the results of thromboelastography （TEG） and D-dimer （D-Di） concentration were compared. [Results] The D-Di values of observation group at Days 2 and 7 after fracture were significantly higher than those of control group （ P %0.05）. The values of R-time and K-time on TEG in observation group at Days 2 and 7 after fracture were significantly shorter than those in control group （ P %0.05）. And R-time and K-time in observation group at Day 2 were significantly shorter than those at Day 7 （ P 〈0.05）. The alpha angle, maximum amplitude （MA）, elastic shear modulus （G） and crack index （CI） in observation group at Days 2 and 7 after fracture was significantly different from those in control group （ P 〈0.05）. And the above data in observation group at Day 2 were significantly different from those at Day 7 （ P 〈0.05）. [Conclusion] Coagulation increases within 24h after intertrochanteric fracture and blood became hypercoagulable with elapsing time. Necessary intraoperative measures should be taken to prevent the formation of venous thrombosis.