下肢骨折术前深静脉彩超与下腔静脉滤器防控肺栓塞的临床意义

Prevention and control of pulmonary embolism by deep venous color Doppler ultrasonography and inferior vena cava filter for lower limb fractures before surgery

目的 探讨下肢骨折术前常规下肢静脉彩色多普勒超声筛查出深静脉血栓形成（DVT）后放置下腔静脉滤器预防致命性肺栓塞（PE）的临床意义。方法 自2011-05—2013-11诊治中老年下肢骨折124例,骨折部位：骨盆骨折5例,髋部骨折48例,膝关节周围骨折15例,股骨干骨折22例,胫骨伴或不伴腓骨骨折19例,下肢多发骨折15例。所有患者在手术当天早晨,一般于术前0.5-3.0 h到B超室进行下肢动脉及静脉血管彩色多普勒超声检查。筛查发现下肢DVT后,停常规手术,急诊置入下腔静脉滤器后再完成骨折手术。结果 124例中出现DVT 24例,均为新发生的血栓。血栓部位：患侧髂静脉、股静脉、腘静脉及小腿深静脉均充满血栓者1例,双下肢股静脉、腘静脉及小腿深静脉血栓者2例,单纯患肢股静脉16例,单纯患肢腘静脉5例。4例未放置下腔静脉滤器,其中1例拒绝放置滤器自动出院,3例要求溶栓及抗凝治疗,错过骨折最佳手术时机。20例成功放置下腔静脉滤器,当日及次日进行骨折手术。9例术后3周内取出滤器;4例滤器上有大量血栓栓子,血栓拦截成功,避免了PE,滤器不予取出;7例在明确留置滤器利弊后自愿选择终生留置滤器。结论 下肢骨折患者术前血管彩色多普勒超声检查出下肢DVT后急诊放置下腔静脉滤器,然后再进行骨折手术,可避免PE及猝死风险,为下肢骨折手术治疗提供安全保障。

Objective To explore the value of placing inferior vena cava filter to prevent fatal pulmonary embolism by screening preoperative deep venous thrombosis using color Doppler ultrasonography before lower limb fracture surgery. Methods From May 2011 to Nov. 2013, there were 124 elderly patients with lower limb fracture surgery, including 5 cases of pelvis fracture, 48 cases of hip fracture, 15 cases of knee joint fracture, 22 cases of femoral fracture, 19 cases of tibiofibula fracture, 15 cases of lower limb multiple fractures. All of the patients were checked using color Doppler ultrasonography in the morning before surgery to screen lower extremity venous thrombosis, the examination time would be 0.5-3.0 h before surgery. The patients with lower extremity venous thrombosis received inferior vena cava f＇dter to prevent fatal pulmonary embolism before the orthopaedic surgery. Results Twenty four cases were found with DVT in 124 cases, and all of which were new thrombus. Thrombus site： the ipsilateral iliac vein, femoral vein and popliteal vein and calf deep vein were all filled with thrombus in 1 case, double lower limb femoral vein and popliteal vein and calf deep venous thrombosis in 2 cases, only femoral vein were filled with thrombus in 16 cases, simple limb pepliteal vein in 5 eases. Four cases were without vena eava filter： 1 case refused to place the filter and automatically discharged, 3 cases required＇thrombolysis and anticoagulation and missed the best surgical opportunity for fracture. Twenty cases were successfully placed inferior vena cava filter, and finished fracture surgery the same day or the next day. Nine eases were removed the filter within 3 weeks after operation; thrombus with a large number of embulus on the filter were successfully intercepted in 4 cases, avoiding the PE, and the filter was not removed; 7 cases chose not to remove the filter for lifelong after understanding the risks of reserved filter. Conclusion Placing inferior vena cava filter, for the patients with fracture of lower limb to prevent pulmonary embolism and stroke risk, can provide security for the lower limb fracture surgery.