血栓弹力图在老年股骨颈骨折围术期抗凝起止点选择中的作用研究

Perioperative anticoagulation of thrombelastogram in the treatment of femoral neck fracture in the elderly

目的探讨血栓弹力图在老年股骨颈骨折患者围术期使用抗凝药物起止点选择中的评估作用和决策意义。方法以2016年2月至2018年12月在我院骨科就诊并治疗的82例老年股骨颈骨折患者为研究对象,按照随机数字表法分为术前干预组(41例)和术后干预组(41例),其中术前干预组男25例、女16例,Garden分型II型2例、III型13例、IV型26例,致伤原因跌倒38例、车祸伤3例;术后干预组男21例、女20例,Garden分型II型1例、III型10例、IV型30例,致伤原因跌倒39例、车祸伤2例。术前干预组在入院后予以依诺肝素钠抗凝治疗,术后干预组在术后予以依诺肝素钠抗凝治疗。分别在入院时、手术前、术后1天、术后7天、术后3周、术后5周对患者进行血栓弹力图检测,并通过彩色超声多普勒检查明确下肢静脉血栓形成情况。结果两组患者在性别、年龄、体质量指数、骨折部位、骨折分型、起病时间差异均无统计学意义。入院时两组患者血栓弹力图检查均提示高凝状态,差异无统计学意义。术前、术后1天、术后7天两组患者仍呈高凝状态,但术前干预组的R值和K值均高于术后干预组,而Angle值、MA值较术后干预组显著降低。术后3周、术后5周两组患者血栓弹力图检查均提示凝血功能恢复至正常范围。彩色超声多普勒检查发现术后7天时术前干预组有1例发生下肢深静脉血栓,而术后干预组有3例发生下肢深静脉血栓,两组发生率差异无统计学意义。两组患者手术情况与并发症发生情况差异无统计学意义。结论血栓弹力图可作为老年股骨颈骨折围术期抗凝起止点选择的评价指标,老年股骨颈骨折围术期建议于入院后即刻使用抗凝治疗并至少持续至术后3周。

Objective To assess the effect of perioperative thrombelastogram on the choosing of the starting and end points of anticoagulation in the treatment of femoral neck fracture in the elderly.Methods A total of 82 elder patients with femoral neck fracture were recruited from Jan.2016 to Dec.2018.All patients were randomly divided into preoperative treatment group (n=41) and postoperative treatment group (n=41).Preoperative treatment group:25 males and 16 females;2 cases of Garden type II,13 cases of Garden type III and 26 cases of Garden type IV;38 cases were of falling and 3 cases were of traffic accident;enoxaparin sodium was applied preoperatively.Postoperative treatment group:21 males and 20 females;1 case of Garden type II,10 cases of Garden type III and 20 cases of Garden type IV;39 cases were of falling and 2 cases were of traffic accident;enoxaparin sodium was applied postoperatively.Thrombelastogram was used to detect the anticoagulation at admission,pre-operation,1 day after operation,7 days after operation,3 weeks after operation and 5 weeks after operation.Color Ultrasound Doppler was used to present the deep vein thrombosis.Results No significant differences in the gender,age,BMI index,fracture site,fracture type and onset time was observed between the two groups.Hypercoagulation was observed by the thrombelastogram in both groups at admission,pre-operation,1 day after operation,and 7 days after operation.The R and K value of the preoperative treatment group were higher than those of the postoperative treatment group,while the angle value and the MA value were lower in the preoperative treatment group.Thrombelastogram results indicated that anticoagulation returned to normal 3-5 weeks postoperatively.Color Ultrasound Doppler presented 1 case of deep vein thrombosis in the preoperative treatment group 7 days after operation and 3 cases in the postoperative treatment group,while no significant differences were noted between the two groups.There were no significant differences in operation data and complications between the two groups.Conclusions Thrombelastogram could be an evaluation index to choose the starting and end points of perioperative anticoagulation for elder patients with femoral neck fracture.Anticoagulation treatment is suggested to begin at admission to 3 weeks after operation at least.