老年髋部骨折患者术前健侧与患侧下肢深静脉血栓形成特点的比较
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摘要
目的比较老年髋部骨折患者术前健侧与患侧下肢深静脉血栓的发生率、好发部位、形成时间,探讨早期预防与治疗下肢深静脉血栓的临床意义。方法回顾性分析自2013-09—2017-11诊治的500例老年髋部骨折,17例术前健侧下肢发现深静脉血栓(健肢组),40例术前患侧下肢发现深静脉血栓(患肢组)。比较2组下肢深静脉血栓发生率、好发部位、形成时间,以及住院时间、末次随访时髋关节功能Harris评分。结果健肢组下肢深静脉血栓发生率为3.4%,患肢组为8.0%;健肢组下肢深静脉血栓发生率低于患肢组,差异有统计学意义(P <0.05)。健肢组与患肢组伤后3 d内血栓发生率、伤后>3 d血栓发生率、中央型深静脉血栓发生率、周围型深静脉血栓发生率差异无统计学意义(P>0.05)。57例均获得随访,随访时间平均14.4(9～18)个月。健肢组与患肢组在住院时间、末次随访时髋关节功能Harris评分差异无统计学意义(P>0.05)。结论老年髋部骨折患者也容易出现健侧下肢深静脉血栓,以肌间静脉血栓为主,多发生于伤后3 d内。患者入院后应常规进行双下肢彩色多普勒超声检查,积极预防深静脉血栓形成。
Objective To compare the incidence, predilection site and time of deep venous thrombosis(DVT) in unaffected and affected legs in elderly patients with hip fracture before operation, and to explore the clinical significance of prevention and treatment of DVT of legs in early time. Methods The clinical data of 500 patients with hip fracture treated from September 2013 to November 2017 were analyzed retrospectively. DVT was found in unaffected leg in 17 patients before operation(unaffected group), DVT was found in affected leg in 40 patients before operation(affected group). The incidence,predilection site and time of DVT, the length of hospitalization, the Harris score of hip function at the last follow-up between the two groups were compared. Results The incidence of DVT was 3.4% in unaffected group and 8.0% in affected group.The incidence of DVT in unaffected group was lower than that in affected group(P <0.05). There were no significant difference in the incidence of thrombosis within 3 days after injury and over 3 days after injury, in the incidence of central DVT and peripheral DVT between the two groups(P >0.05). Fifty-seven patients were followed up from 9 to 18 months, with an average of 14.4 months. There was no significant difference in Harris score of hip function last follow-up and in hospitalization between the two groups(P >0.05). Conclusion DVT of the unaffected legs also occurred in elderly patients with hip fracture, the intermuscular vein thrombosis is predominant in the DVT, the DVT often occurred within 3 days after injury. The patients should be routinely examined by color Doppler ultrasound in both legs to actively prevent DVT.
Objective To compare the incidence, predilection site and time of deep venous thrombosis(DVT) in unaffected and affected legs in elderly patients with hip fracture before operation, and to explore the clinical significance of prevention and treatment of DVT of legs in early time. Methods The clinical data of 500 patients with hip fracture treated from September 2013 to November 2017 were analyzed retrospectively. DVT was found in unaffected leg in 17 patients before operation(unaffected group), DVT was found in affected leg in 40 patients before operation(affected group). The incidence,predilection site and time of DVT, the length of hospitalization, the Harris score of hip function at the last follow-up between the two groups were compared. Results The incidence of DVT was 3.4% in unaffected group and 8.0% in affected group.The incidence of DVT in unaffected group was lower than that in affected group(P <0.05). There were no significant difference in the incidence of thrombosis within 3 days after injury and over 3 days after injury, in the incidence of central DVT and peripheral DVT between the two groups(P >0.05). Fifty-seven patients were followed up from 9 to 18 months, with an average of 14.4 months. There was no significant difference in Harris score of hip function last follow-up and in hospitalization between the two groups(P >0.05). Conclusion DVT of the unaffected legs also occurred in elderly patients with hip fracture, the intermuscular vein thrombosis is predominant in the DVT, the DVT often occurred within 3 days after injury. The patients should be routinely examined by color Doppler ultrasound in both legs to actively prevent DVT.
引文
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[10]肖湘,冯凯强,袁宇,等.老年骨质疏松性髋部骨折患者术前下肢深静脉血栓患病率及危险因素分析[J].中华骨科杂志,2015,35(11):1084-1090.
[11] Palareti G. How I treat isolated distal deep vein thrombosis(IDDVT)[J]. Blood,2014,123(12):1802-1809.
[12] Almosni J,Meusy A,Frances P,et al. Practice variation in the management of distal deep vein thrombosis in primary vs. secondary cares:a clinical practice survey[J]. Thromb Res,2015,136(3):526-530.
[13] Kearon C,Akl EA,Ornelas J,et al. Antithrombotic therapy for VTE disease:CHEST guideline and expert panel report[J]. Chest,2016,149(2):315-352.
[14] Spahn DR,Bouillon B,Cerny V,et al. Management of bleeding and coagulopathy following major trauma:an updated European guideline[J]. Crit care,2013,17(2):R76.
[15] Carr S,Chan K,Rosenberg J,et al. Correlation of the diameter of the left common iliac vein with the risk of lower-extremity deep venous thrombosis[J]. J Vas Interv Radiol,2012,23(11):1467-1472.
[16] Peleg K,Rozenfeld M,Radomislensky I,et al. Policy encouraging earlier hip fracture surgery can decrease the long-term mortality of elderly patients[J]. Injury,2014,45(7):1085-1090.
[17]常晓,钱文伟,翁习生,等.股骨颈骨折对人工髋关节术后深静脉血栓形成影响的病例对照研究[J].中国骨伤,2012,25(5):389-392.
[18] Smith EB,Parvizi J,Purtil JJ. Delayed surgery for patients with femur and hip fracture-risk of deep venous thrombosis[J]. J Trauma,2011,70(6):E113-116.
[2] Bashir R,Zack CJ,Zhao H,et al. Comparative outcomes of catheterdirected thrombolysis plus anticoagulation vs anticoagulation alone to treat lower-extremity proximal deep vein thrombosis[J]. JAMA Intern Med,2014,174(9):1494-1501.
[3] Fujita Y,Nakatsuka H,Namba Y,et al. The incidence of pulmonary embolism and deep vein thrombosis and their predictive risk factors after lower extremity arthroplasty:a retrospective analysis based on diagnosis using multidetector CT[J]. J Anesth,2015,29(2):235-241.
[4] Buyukyilmaz F,Sendir M,Autar R,et al. Risk level analysis for deep vein thrombosis(DVT):a study of turkish patients undergoing major orthopedic surgery[J]. J Vasc Nurs,2015,33(3):100-105.
[5]彭志平,林云.彩超对下肢骨折术前深静脉血栓筛查的意义[J].中国超声医学杂志,2013,29(2):167-169.
[6] Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg Am,1969,51(4):737-755.
[7]臧加成,马信龙,马剑雄,等.不同部位骨折深静脉血栓发生率的流行病学研究[J].中华骨科杂志,2016,36(9):540-545.
[8]俞斌,季英,禹宝庆.下肢深静脉血栓的诊断及治疗进展[J].中国骨与关节损伤杂志,2017,32(1):109-111.
[9] Gornik HL,Sharma AM. Duplex ultrasound in the diagnosis of lower-extremity deep venous thrombosis[J]. Circulation,2014,129(8):917-921.
[10]肖湘,冯凯强,袁宇,等.老年骨质疏松性髋部骨折患者术前下肢深静脉血栓患病率及危险因素分析[J].中华骨科杂志,2015,35(11):1084-1090.
[11] Palareti G. How I treat isolated distal deep vein thrombosis(IDDVT)[J]. Blood,2014,123(12):1802-1809.
[12] Almosni J,Meusy A,Frances P,et al. Practice variation in the management of distal deep vein thrombosis in primary vs. secondary cares:a clinical practice survey[J]. Thromb Res,2015,136(3):526-530.
[13] Kearon C,Akl EA,Ornelas J,et al. Antithrombotic therapy for VTE disease:CHEST guideline and expert panel report[J]. Chest,2016,149(2):315-352.
[14] Spahn DR,Bouillon B,Cerny V,et al. Management of bleeding and coagulopathy following major trauma:an updated European guideline[J]. Crit care,2013,17(2):R76.
[15] Carr S,Chan K,Rosenberg J,et al. Correlation of the diameter of the left common iliac vein with the risk of lower-extremity deep venous thrombosis[J]. J Vas Interv Radiol,2012,23(11):1467-1472.
[16] Peleg K,Rozenfeld M,Radomislensky I,et al. Policy encouraging earlier hip fracture surgery can decrease the long-term mortality of elderly patients[J]. Injury,2014,45(7):1085-1090.
[17]常晓,钱文伟,翁习生,等.股骨颈骨折对人工髋关节术后深静脉血栓形成影响的病例对照研究[J].中国骨伤,2012,25(5):389-392.
[18] Smith EB,Parvizi J,Purtil JJ. Delayed surgery for patients with femur and hip fracture-risk of deep venous thrombosis[J]. J Trauma,2011,70(6):E113-116.
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