利伐沙班与低分子肝素对老年髋部骨折PFNA术后隐性失血的对比研究

Comparative Study between Rivaroxaban and Low Molecular Heparin in Hidden Blood Loss after PFNA Treatment for Intertrochanteric Fractures

目的比较利伐沙班与低分子肝素对老年髋部骨折股骨近端防旋髓内钉（proximal femoral nail anti-rotation,PFNA）固定术后隐性失血的影响。方法在武汉市中南医院2011-06/2016-04月PFNA固定股骨转子间骨折523例病例中,根据年龄（65-75岁）,体质量指数（body mass index,BMI）（18-24 kg/m2）、无心脑内科疾病（高血压、冠心病、脑中风偏瘫后遗症）,筛选出完整病例127例,根据术后使用不同抗凝药物分为利伐沙班组（72例）、低分子肝素组（55例）,通过Gross方程计算隐性失血量,比较两组之间的差异。结果利伐沙班组大腿周径增加（2.05±0.75）cm,低分子肝素组大腿周径增加（2.09±0.93）cm,两者比较差异无统计学意义（P〉0.05）。利伐沙班组失血总量为（437.28±42.57）ml,隐性失血量为（346.43±31.57）ml;低分子肝素组失血总量为（469.43±32.75）ml,隐性失血量为（382.14±27.25）ml,两者比较差异有统计学意义（P〈0.05）。结论与低分子肝素相比,利伐沙班对老年股骨转子间骨折PFNA固定术后隐性失血的影响较小,能有效降低髋部骨折围手术期的并发症。

Objective To compare the effects of rivaroxaban and low molecular heparin on hidden blood loss after proximal femoral nail anti-rotation（PFNA）treatment for intertrochanteric fractures.Methods A total of 523 cases were all done closed reduction PFNA fixation of intertrochanteric fractures in Zhongnan hospital of Wuhan University from June 2011 to April 2016,depended on the age（65-75 years）,body mass index（BMI）（18-24 kg/m2）,no cardiovascular diseases（hypertension,coronary heart disease,cerebral apoplexy hemiplegy sequela）,screened out 127 cases at the end.According to different anticoagulant drugs after surgery,assigned into rivaroxaban group（n=72）and low molecular heparin group（n=55）.The hidden blood loss was calculated in two groups by Gross equation,and compared differences between them.Results It was no significant difference between rivaroxaban group（2.05±0.75）cm and low molecular heparin group（2.05±0.75）cm（P〉0.05）.The total blood loss was（437.28±42.57）ml and the hidden blood loss was（346.43±31.57）ml in the rivaroxaban group.The total blood loss was（469.43±32.75）ml and the hidden blood loss was（382.14±27.25）ml in the low molecular heparin group.There was significant difference between two groups（P〈0.05）.Conclusion Comparing with low molecular heparin,rivaroxaban has a smaller effect on hidden blood loss after PFNA treatment for intertrochanteric fractures and reduces perioperative complications effectively.