老年胫腓骨骨折患者术后并发肺血栓形成预后分析

The postoperative thromboembolism prognosis analysis of tibia and fibula fractures in the elderly patients

目的:探讨不同手术方法治疗老年胫腓骨骨折患者对肺血栓形成与预后的影响。方法:选择2013年2月到2015年12月在我院诊治的老年胫腓骨骨折患者84例,根据随机数字表法分为观察组与对照组各42例,对照组采用传统内固定手术治疗,观察组采用单臂外固定支架治疗,观察两组肺血栓形成与预后情况。结果:观察组和对照组的完全负重时间和腓骨愈合时间比较差异无统计学意义(P>0.05),但观察组部分负重时间与胫骨愈合时间明显长于对照组(P<0.05)。观察组与对照组术后8周的优良率分别为83.3%和88.1%,两组比较差异无统计学意义(P>0.05)。观察组术后8个月下肢深静脉血栓形成与肺血栓形成发生率分别为4.8%和2.4%,而对照组分别为26.2%和11.9%,观察组都明显低于对照组(P<0.05)。观察组与对照组术后8周的血浆D-二聚体含量分别为(225.24±45.33)和(523.21±39.56)μg·L-1,观察组明显低于对照组(t=22.005,P<0.05)。结论:相对于内固定手术治疗,单臂外固定支架治疗老年胫腓骨骨折仍然具有很好的疗效,能减少肺血栓形成的发生率,其机制可能与调节血浆D-二聚体表达有关。

Objective： To explore the postoperative thromboembolism prognosis of tibia and fibula fractures in the elderly patients by different surgical treatments. Methods： From February 2013 to December 2015 in our hospital,84 elderly patients with tibia and fibula fracture for treatment were selected,and equally divided into observation group and control group according to the random number table. Patients in the control group were used the traditional internal fixation,patients in the observation group were given the external fixation treatment. The pulmonary thrombosis and prognosis in the two groups were observed. Results： The full weight-bearing and fibula healing times in the two groups had no significant difference（ P〉0. 05）,while the part of the load time and tibia healing time in the observation group were significantly longer than the control group（ P〈0. 05）. The postoperative8 weeks excellent rates in the observation group and control group were 83. 3% and 88. 1% respectively,with no significant difference（ P〉0. 05）. The postoperative 8 weeks incidence of deep venous thrombosis and pulmonary thrombosis in the observation group were 4. 8% and 2. 4% respectively,while the control group were 26. 2% and11. 9%,those in the observation group were significantly lower than the control group（ P〈0. 05）. The postoperative 8 weeks plasma D-dimer levels in the observation group and control group were（ 225. 24 ± 45. 33） and（ 523. 21 ± 39. 56） μg · L^- 1,that in the observation group was significantly lower（ t = 22. 005,P〈0. 05）.Conclusion： Compared to internal fixation,external fixation in the treatment of tibia and fibula fracture in the elderly patients still has good effect,it can reduce the incidence of pulmonary thrombosis,which may be related to the regulate of the expression of the plasma D-dimer.