低分子量肝素钙对股骨近端防旋髓内钉治疗股骨粗隆间骨折隐性失血和深静脉血栓形成的影响

Effect of low molecular weight heparin calcium on hidden blood loss and deep vein thrombosis of femoral intertrochanteric fracture treated by proximal femoral anti-rotation intramedullary nail

目的探讨围术期使用低分子量肝素钙(LMWH Ca)对股骨近端防旋髓内钉(PFNA)内固定治疗股骨粗隆间骨折隐性失血和术后下肢深静脉血栓情况的影响。方法回顾性分析使用PFNA内固定治疗股骨粗隆间骨折的92例患者资料。根据围术期是否使用LMWH Ca分为2组。LMWH Ca组(n=42)术前和术后使用低分子量肝素钙;对照组(n=50)围术期不使用低分子量肝素钙。记录并且比较2组患者的术中出血量、术中输入红细胞量、术后引流量、术后2 d内输血率,并计算2组显性失血量、隐性失血量、围术期总失血量。观察术后下肢深静脉血栓和术后并发症发生情况。结果 2组的术中出血量、术中输入红细胞量、术后引流量、术后2 d内输血率、显性失血量、隐性失血量、围术期总失血量相比差异无统计学意义(P>0. 05)。LMWH Ca组术后下肢深静脉血栓发生率为2. 3%,显著低于对照组的14. 0%,差异有统计学意义(P <0. 05)。结论PFNA内固定治疗股骨粗隆间骨折围术期使用低分子量肝素钙,可以显著降低术后下肢深静脉血栓的发生,且对患者术中出血量、术后引流量、显性失血量、隐性失血量、围术期总失血量无显著影响。

Objective To explore the effect of low molecular weight heparin calcium(LMWH Ca) on the hidden blood loss and deep vein thrombosis in the surgery of femoral intertrochanteric fracture treated with proximal femoral anti-rotation intramedullary nail(PFNA). MethodsThe data of 92 patients with intertrochanteric fracture treated with PFNA in our hospital were retrospectively analyzed, and were divided into two groups according to whether or not low LMWH Ca was used. LMWH Ca group( n =42)used low molecular weight heparin in preoperation and postoperation, but the control group didn′t use in perioperation. The surgical blood loss, operative blood transfusion, drainage after operation, 2-day transfusion rate after operation were recorded. The dominant, hidden and total blood loss in perioperation were calculated. The incidences of deep venous thrombosis and complications of lower extremity after operation were compared. Results There were no significant differences in the surgical blood loss, the operative blood transfusion, drainage after operation, 2-day transfusion rate after operation, the dominant blood loss, hidden blood loss and total blood loss in two groups( P > 0.05). The incidence rate of deep venous thrombosis was significantly lower in LMWH Ca group than that in the control group(2.3% vs. 14.0%, P <0.05). ConclusionPreoperative administration of LMWH Ca can reduce postoperative deep venous thrombosis of lower extremity, and has no influenceon intraoperative surgical blood loss, postoperative drainage volume, dominant, hidden and total blood loss.