不停用氯吡格雷早期髓内固定治疗老年股骨转子间骨折围手术期的安全性研究  

Prompt surgical treatment for intertrochanteric fracture in patients receiving clopidogrel

作　　者：张建政[1] 高杰[1] 韩力[1] 王晓伟[1] 杜雨轩[1] 任继鑫[1] 孙天胜[1] 刘智[1] 

机构地区：[1]北京军区总医院全军创伤骨科研究所,100700

出　　处：《中华创伤骨科杂志》2016年第8期720-724,共5页Chinese Journal of Orthopaedic Trauma

基　　金：北京市科学技术委员会首都培育项目（Z141100002114030）

摘　　要：目的探讨不停用氯吡格雷早期髓内固定治疗老年股骨转子间骨折是否会增加患者围手术期的并发症。方法回顾性分析2012年1月至2013年12月期间采用股骨近端髓内钉固定治疗的238例老年股骨转子间骨折患者资料，根据术前是否使用氯吡格雷分为氯吡格雷组和非氯吡格雷组。氯吡格雷组32例，为长期口服氯吡格雷且术前不停用的患者；非氯吡格雷组206例，为未使用过氯吡格雷的患者。氯吡格雷组患者术前美国麻醉医师协会分级高于非氯吡格雷组患者，合并动脉支架术后、冠状动脉粥样硬化性心脏病多于非氯吡格雷组患者，差异均有统计学意义（P〈0．05）。比较两组患者的手术时间、重症医学监护室（ICU）时间、术后血红蛋白、住院时间、术后输血量，以及术后切口局部并发症、全身并发症的发生率、死亡率等。结果两组患者的手术时间、术中出血量、术后引流血量、术后血红蛋白和术后输血量比较差异均无统计学意义（P〉0．05）。氯吡格雷组患者的ICU时间[（1．7±0．9）d]和住院时间[（12．5±2．5）d]显著长于非氯吡格雷组患者[（0．9±0．5）、（9．3±1．9）d]，差异均有统计学意义（P〈0．05）。氯吡格雷组与非氯吡格雷组患者术后1个月内切口局部并发症发生率（9．4％、7．8％）、全身并发症发生率（25．0％、16．0％）、死亡率（9．4％、4．4％）比较差异均无统计学意义（P〉0．05）。结论不停用氯吡格雷早期髓内固定治疗老年股骨转子间骨折，围手术期不会明显增加患者局部和全身并发症。Objective To explore the safety of hip fracture surgery in the aged patients who are taking elopidogrel at the time of surgery. Methods A retrospective study was performed to analyze the 238 aged patients with femoral intertrochanteric fracture who had received femoral proximal intramedullary nailing between January 2012 and December 2013. Of them, 32 took oral clopidogrel for a long time and did not stop the medication at the time of surgery while 206 never used elopidogrel. The American Society of Anesthesiologists （ASA） score, combined post-artery stenting and coronary atherosclerotic cardiopathy in the clopidogrel group were significantly higher than in the non-clopidogrel group （ P 〈 0.05）. The 2 groups were compared in terms of operation time, ICU time, postoperative hemoglobin, hospital stay, postoperative transfusion, local and general complications, and mortality. Results There were no significant differences between the 2 groups in operation time, intraoperative bleeding, postoperative drainage volume, postoperative hemoglobin, or postoperative transfusion （P 〉 0.05） . The ICU time （1.7 ±0.9 d） and hospital stay （12.5 ±2.5 d） for the clopidogrel group were significantly longer than for the clopidogrel group（0.9 ± 0.5 d, 9.3 ± 1.9 d） （ P 〈 0.05） . There were no significant differences between the 2 groups either in local complication rate （9.4% versus 7.8% ）, general complication rate （25.0% versus 16.0% ） or mortality （9.4% versus 4.4% ） （ P 〉 0. 05）. Conclusion It is safe to perform prompt surgical treatment of hip fracture for aged patients receiving clopidogrel.

关 键 词：髋骨折 氯吡格雷 骨折固定术 髓内 骨钉 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]