高龄股骨颈骨折人工股骨头置换术后利伐沙班预防深静脉血栓的临床观察  

Clinical observation of different course duration of rivaroxaban in preventing deep venous thrombosis after artificial femoral head replacement in elderly patients with femoral neck fracture

作　　者：季英[1] 潘利智 柳亚男[1] 顾建芳[2] 

机构地区：[1]复旦大学附属上海市浦东医院骨科,上海201399 [2]复旦大学附属上海市浦东医院护理部,上海201399

出　　处：《中华创伤杂志》2018年第2期164-168,共5页Chinese Journal of Trauma

基　　金：上海市卫生和计划生育委员会科研课题（201440057）

摘　　要：目的探讨高龄股骨颈骨折人工股骨头置换术后不同疗程利伐沙班对深静脉血栓（DVT）的预防效果及安全性。方法采用前瞻性病例对照研究分析2015年2月-2017年7月收治的95例高龄股骨颈骨折患者临床资料。纳入标准：（1）年龄≥70岁，伤后24h内入院；（2）经X线片确诊为新鲜移位股骨颈骨折，Garden分型Ⅲ型或Ⅳ型；（3）行人工股骨头置换术；（4）认知能力正常，签署患者知情同意书，术后配合进行6周随访。其中男18例，女77例；年龄70—98岁，平均80．8岁。骨折Carden分型：Ⅲ型85例，Ⅳ型10例。患者均行人工股骨头置换手术，按随机数字表法分为口服利伐沙班2周组（A组，34例）、口服利伐沙班3周组（B组，31例）、口服利伐沙班5周组（C组，30例）。术后通过2，3，5周不同疗程分别给予每天口服1次利伐沙班10mg。比较三组一般资料、术前及术后6周血红蛋白和血小板计数、术后6周输血率及DVT发生情况。结果三组在性别、年龄、体重指数、骨折分型、受伤至手术时间、术中出血量、术后负压引流量、伴随基础疾病等方面，差异均无统计学意义（P〉0．05）。A、B、C三组患者术后6周血红蛋白及血小板计数比较差异无统计学意义（P〉0．05）；术后6周输血率分别为9％（3／34）、3％（1／31）、3％（1／30）（P〉0．05）。术后DVT发生率A组为21％（7／34），B组为13％（4／31），c组为0，其中A组与B组比较，差异无统计学意义（P〉0．05），B组与C组比较差异无统计学意义（P〉0．05），A组与C组比较差异有统计学意义（P〈0．05）。结论高龄股骨颈骨折人工股骨头置换术后口服利伐沙班时间延长至5周可有效预防DVT发生，且不增加出血风险。Objective To investigate the efficacy and safety of different course duration of rivaroxaban for deep venous thrombosis （DVT） in elderly patients with femoral neck fractures after artificial femoral head replacement. Methods A prospective case control study was conducted on 95 elderly cases of femoral neck fractures treated from February 2015 to July 2017. There were 18 males and 77 females, with average age of 80.8 years （range, 70-98 years）. There were 85 patients at stage III and 10 at stage IV according to Garden classification. All patients received artificial femoral head replacement and were randomly divided into 3 groups （ Group A： 34 cases, rivaroxaban treatment for 2 weeks; Group B： 31 cases, rivaroxaban treatment for 3 weeks; Group C： 30 cases, rivaroxaban treatment for 5 weeks）. At 2,3 and 5 weeks after operation, the patients were given 10 mg oral rivaroxaban once daily. General information, blood transfusion rate, hemoglobin volume, platelet countand DVT rate were recorded before and 6 weeks after operation. Results No significant difference among the groups in terms of division, age, body mass index, fracture classification, time interval from injury, intraoperative blood loss, quantity of drainage fluid after operation, and associated underlying diseases was observed （P 〉 0. 05 ）. The blood transfusion rate of Groups A, B and C within 2 weeks after operation was 9% （3/34）, 3% （ 1/31 ） and 3% （1/30） （P 〉 0. 05） respectively. The comparative difference in hemoglobin and platelet count had no statistical significance （ P 〉 0.05 ）. The DTV rate after operation of Groups A, B and C was 21% （7/34）, 13% （4/31） and 0, respectively. There was no significant difference between Groups B and C （ P 〉 0. 05 ） , but the difference between Groups A and C was statistically significant （P 〈 0. 05 ）. Conclusions For elderly patients with femoral neck fracture who underwent the artificial femoral head replacement, it is effective to prevent the occur

关 键 词：静脉血栓栓塞 抗凝药 关节形成术  置换  髋 利伐沙班 

分 类 号：R687.3[医药卫生—骨科学]