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  

A study about prevalence rate and risk factors of preoperative deep venous thrombosis of osteoporotic hip fracture in senile patients

作　　者：肖湘[1] 冯凯强[2] 袁宇[3] 黄津[2] 王毅[2] 

机构地区：[1]天津市天津医院创伤科,300211 [2]天津市天津医院检验科,300211 [3]天津市天津医院物理诊断科,300211

出　　处：《中华骨科杂志》2015年第11期1084-1090,共7页Chinese Journal of Orthopaedics

基　　金：天津市卫生局重点攻关项目（11KG140）

摘　　要：目的 统计老年骨质疏松性髋部骨折患者术前下肢深静脉血栓（deep vein thrombosis, DVT）的患病率, 分析老年骨质疏松性髋部骨折患者DVT相关的危险因素。方法 研究对象为2013年、年龄〉 60岁、低能量损伤的髋部骨折住院治疗患者。根据病历记录, 所有老年骨质疏松性髋部骨折患者入院后24 h内检查双下肢DVT的症状和体征, 检测D-二聚体浓度, 行双侧下肢静脉系统多谱勒超声检查, 并接受术前预防性抗凝治疗。确诊腘静脉及其近端血栓或漂浮血栓的患者需接受下腔静脉滤器（inferior vena caval filters, IVCF）植入术。记录患者年龄、性别、骨折分型、术前24 h D-二聚体浓度、DVT发生时间和部位、术前美国麻醉师协会（American Society of Anesthesiologists, ASA）评分及合并内科疾病（内科基础病、心率失常、贫血、电解质紊乱、低蛋白血症）。统计学分析观察指标与DVT关系。结果 按纳入及排除标准, 946例髋部骨折住院患者中702例患者（股骨颈骨折302例、股骨转子间骨折400例）纳入研究。术前均未出现下肢DVT的症状和体征。伤后多谱勒超声检查结果显示：36例（11.9%）股骨颈骨折患者发生DVT, 男13例, 女23例；平均年龄72.7岁（62~90岁）；与髋部骨折同侧下肢血栓31例, 双侧下肢血栓5例。74例（18.5%）股骨转子间骨折患者发生DVT, 男38例, 女36例, 平均年龄76岁（60~95岁）；与髋部骨折同侧下肢血栓68例, 双侧下肢血栓6例。老年骨质疏松性髋部骨折后第1天下肢DVT患病率最高, 股骨颈骨折患者为41.7%（15/36）和股骨转子间骨折为51.40%（38/74）；超过伤后5天, 下肢DVT发生部位更靠近端且多条静脉并发。血栓以肌间静脉及腘静脉多发。结论 预防老年骨质疏松性髋部骨折患者下肢DVT应从急症诊治开始, 避免危险因素, 早期手术和术后早期功能锻炼。Objective To census the preoperative prevalence rate of deep venous thrombosis （DVT） and to evaluate the risk factors of DVT in senile osteoporotic hip fractured patients. Methods The object of study were patients aged 60 and above, and osteoporotic hip fracture by low energy injury in 2013. Based on medical records, all the patients with osteoporotic hip fracture were evaluated the signs and symptoms of DVT in 24 h, D-dimer test and underwent Doppler ultrasound screening of bilateral venous system in lower extremity after admission, and all the patients received preoperative prophylactic anticoagulation. Patients with popliteal and proximal level thrombus or floating thrombus underwent inferior vena cava （IVC） filter insertion. Outcome measures： age, gender, fracture type, D-dimer value in 24 h preoperatively, occurrence time of DVT and region, grade of preoperative American Society of Anesthesiologists, preoperative medical diseases. Results 702 of 946 hip fracture inpatients were comprised in this retrospective study. All were not founded any symptom or signs of DVT. All patients were took preoperative Doppler ultrasound screening and the Results as follows： 36 of 302 patients（11.9%） with femoral neck fracture were proved preoperative thrombosis（13 male, 23 female）, the average age was 72.7 year-old（range from 62-90 year-old）, on the same side as the fractured hip in 31 patients, bilateral thrombosis in 5 patients. 74 of 400 patients（18.5%） with intertrochanteric fracture were proved preoperative thrombosis（38 male, 36 female）, the average age was 76 year-old（range from 60-95 year-old）, on the same side as the fractured hip in 68 patients, bilateral thrombosis in 6 patients. The most prevalence rate of DVT were in the first day after osteoporotic hip fracture, 15 patients（41.7%） with femoral neck fracture and 38 patients（51.40%） with intertrochanteric fracture. There were more proximal level and multiple level involment thrombosis over 5 days after injury. The most t

关 键 词：髋骨折 老年人 骨质疏松 静脉血栓形成 围手术期 危险因素 

分 类 号：R687.3[医药卫生—骨科学]