老年股骨颈骨折全髋关节置换术围手术期下肢深静脉血栓形成的特点

Features of deep venous thrombosis in aged patients with femoral neck fracture during the perioperative period

目的探讨老年股骨颈骨折行人工全髋关节置换术及规范化预防性抗凝治疗下围手术期下肢深静脉血栓形成的特点。方法回顾性分析2015年1月~2017年6月华中科技大学同济医学院附属普爱医院骨科行人工全髋关节置换的老年患者363例,年龄(66±5)岁,男性114例(31.4%),女性249例(68.6%)。将患者分为股骨颈骨折组(n=187)和非股骨颈骨折组(n=176)。按照《中国骨科大手术静脉血栓栓塞症预防指南》进行规范化血栓预防,对围手术期出现下肢深静脉血栓的患者进行回顾性分析,对比两组患者围手术期深静脉血栓形成的特点。结果骨折组患者中8例出现下肢深静脉血栓,其中2例并发肺栓塞;非骨折组中6例出现下肢深静脉血栓,其中1例并发肺栓塞,差异无统计学意义(X^2=0.185,P>0.05)。骨折组下肢深静脉血栓5例发生于术前,3例发生于术后;非骨折组6例患者均发生于术后,两组比较差异有统计学意义(P<0.05)。结论老年股骨颈骨折全髋关节置换患者术前和术后均易形成下肢深静脉血栓,对于这类特殊的群体,术前血栓防治也应引起足够的重视。

Objective To investigate the formation characteristics of deep venous thrombosis（DVT） in aged patients with femoral neck fracture who underwent total hip arthroplasty （THA） and treatedwith standard prophylatic anticoagulant therapy. Methods A retrospective study was performed in 363 agedpatients 66±5 years cases underwent unilateral THA from January 2015 to June 2017. There were 114 malepatients （31.4%） and 249 female patients （68.6%）. Patients were divided into femoral neck fracture （n=187）and non- fracture （n=176） groups. Two groups were strictly complied ＂China＇s major orthopedic surgeryvenous thromboembolism prevention guidelines＂ for thromboprophylaxis. Retrospectively analyzed andcompared patients with DVT occurred during the perioperative period. Results There were 8 patients （2patients occurred pulmonary embolism） with DVT in fracture group and 6 patients （1 patient occurredpulmonary embolism） with DVT in non-fracture group. Differences had no statistical significance （c2=0.185,P〉0.05）. In fracture group, 5 patients occurred DVT before surgery and 3 after surgery. Meanwhile all 6patients occurred DVT after surgery in the non-fracture group, differences of DVT distribution between twogroups was statistically significant （P〈0.05）. Conclusions DVT was easy formed before and after surgeryin elderly femoral neck fracture patients with THA. For these specific groups, prevention of DVT beforeoperation is the priority.