床旁超声在股骨颈骨折患者围手术期下肢深静脉血栓筛查中的作用  

The clinical value of bedside ultrasound in the screening of perioperative lower extremity deep vein thrombosis in elderly patients with femoral neck fracture

作　　者：姚尧[1] 乔梁[1] 王业贤 邱君斓[2] 蒋智明[2] 沈祎[2] 朱澄妍 陈东阳[1] 徐志宏[1] 史冬泉[1] 戴进[1] 张炜炜[2] 蒋青[1] 

机构地区：[1]南京大学医学院附属鼓楼医院运动医学与成人重建外科,210008 [2]南京大学医学院附属鼓楼医院外科超声室,210008

出　　处：《中华老年骨科与康复电子杂志》2018年第2期70-74,共5页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：国家自然科学基金(81672239)

摘　　要：目的探讨床旁超声在老年股骨颈骨折患者血栓筛查的应用价值。方法回顾性收集2016年1月至2017年3月南京大学医学院附属鼓楼医院运动医学与成人重建外科收治的股骨颈骨折患者,术前常规用床旁超声行双下肢深静脉检查,观察血管内径、血栓部位、血栓回声以及血流情况。所有术前血栓患者于术后行常规随访观察。结果共纳入135例患者,男性45例,女性90例;平均年龄(76±8)岁,平均身体质量指数为(22±3)kg/m^2。术前共发现血栓45例,其中近端血栓7例,远端血栓38例。根据血栓累及部位,其中累及髂静脉1例,股静脉4例,腘静脉4例,腓静脉5例,胫后静脉3例,肌间静脉血栓40例。13例血栓患者暂停手术并接受治疗,治疗期间彩超隔日观察血栓溶解情况,其中经治疗好转10例,血栓无变化2例,加重1例,2例在术前置入下腔静脉滤器。术后彩超观察中,3例术前血栓患者在术后观察中发现进展至其他静脉,均及时接受抗凝治疗并通过床旁彩超随访,未见有血栓脱落以及肺栓塞形成。结论床旁超声可用于股骨颈骨折患者血栓的诊断、监测及随访。Objective To investigate the clinical value of bedside ultrasound in detection of deepvein thrombosis in elderly patients with femoral neck fracture. Methods A retrospective study wasperformed in patients with femoral neck fractures who underwent bilateral ultrasound in department ofSports Medicine and Adult Reconstructive Surgery of Drum Tower Hospital Affiliated to Medical School ofNanjing University from January 2016 to March 2017. The diameter of blood vessel, location, echo andblood flow were evaluated. Postoperative ultrasound were conducted routinely during hospitalization andafter discharge. Results A total of 135 patients were enrolled in this study. There were 45 males and 90females. The average age was 76±8 years old and the average body mass index was 22±3 kg/m2. Forty-fivecases were diagnosed DVT. Seven cases were proximal DVT and thirty eight were distal. According to theanatomical location, one located in the iliac vein, four located in the femoral veins, four located in thepopliteal veins, five cases located in the peroneal veins and three cases located in the posterior tibia veins,forty one cases located in the muscular vein. Surgeries were postponed in 13 DVT patients and all of themreceived thrombosis treatment and ultrasound screening every other day. Results showed that 10 cases weresignificantly improved, two cases had no improvement and one case aggravated, two cases received inferiorvena cava filters. During postoperative screening, three preoperative DVTs were found to progress into other veins and all of them received treatment and the follow-up screening showed that no DVT failed off and nopulmonary embolism happened. Conclusion Bedside ultrasound can be used in the diagnosis, monitoringand follow up of DVT in patients with femoral neck fracture.

关 键 词：血栓形成 多普勒超声 股骨颈骨折 关节成形术 置换 髋 

分 类 号：R687.3[医药卫生—骨科学]