骨质疏松性脊柱新鲜性压缩骨折中老年患者的凝血功能变化  

Changes in blood coagulation in middle-aged and elderly patients with fresh vertebral compression fractures

作　　者：越雷 孙浩林[1] 李淳德[1] Yue Lei;Sun Haolin;Li Chunde(Department of Orthopaedics,The First Affiliated Hospital to Peking University,Beijing 100433,China)

机构地区：[1]北京大学第一医院骨科,100034

出　　处：《中华创伤骨科杂志》2019年第11期973-977,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨脊柱新鲜性压缩骨折对中老年骨质疏松性骨折患者凝血功能的短期内影响。方法回顾性分析2016年1月至2018年12月之间北京大学第一医院骨科收治的70例脊柱新鲜性压缩性骨折中老年患者资料和70例脊柱退行性变中老年患者资料,分别设为骨折组和退变组。采集基线参数包括性别、年龄、美国麻醉师协会分级,术前血液参数包括凝血指标D-二聚体、纤维蛋白(原)降解产物(FDP)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、国际标准化比率(INR)、凝血酶时间(TT)及血小板指标,骨折组疾病参数包括脊柱骨折节段数量及骨折病史时长。将两组患者按照年龄段分为5个年龄段:50~90岁之间每10岁为一段,>90岁为1段。比较两组各相应年龄的D-二聚体和FDP值。统计分析年龄校正前、后D-二聚体阴性患者比例,以及各凝血指标及血小板之间的相关性等。结果两组患者之间基线参数差异均无明显统计学意义(P>0.05)。骨折组的平均发病时间为6.7 d。骨折组的D-二聚体、FDP、PT、INR、TT和FIB均明显高于退变组,差异均有统计学意义(P<0.001)。而年龄校正D-二聚体阈值后,骨折组中75.71%(53/70)的患者D-二聚体阴性,而退变组98.57%(69/70)的患者为阴性。同时D-二聚体和FDP具有显著的相关性(P<0.001),两者Pearson相关系数为0.932。与退变组比较,骨折组D-二聚体和FDP在61~90岁年龄段增高更为明显,差异有统计学意义(P<0.001)。结论脊柱新鲜性压缩骨折对于中老年骨质疏松患者凝血功能有显著的影响,推测中、老年脊柱新鲜性压缩骨折患者发生静脉血栓事件的风险较脊柱退行性变患者可能更高。Objective To explore the short-term effects of fresh vertebral compression fracture on blood coagulation in middle-aged and elderly osteoporotic patients.Methods A retrospective analysis was conducted of the 140 middle-aged and elderly patients(70 ones with fresh vertebral compression fracture and 70 ones with degenerative spinal disease)who had been treated at Department of Orthopaedics,The First Affiliated Hospital to Peking University between January 2016 and December 2018.Collected were their baseline parameters including age,gender and American Society of Anesthesiologists(ASA)scores,preoperative blood parameters including coagulation indicators[D-Dimer,fibrinogen degradation product(FDP),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),international normalized ratio(INR)and thrombin time(TT)]and platelets indicators,and fracture parameters including number of fractured vertebrae and duration of fracture.The 2 patients groups were divided into 5 age groups:4 age groups for each 10 between 50 and 90 years and one age group for>90 years.The values of D-Dimer and FDP were compared between the 2 patient groups in each corresponding age group.The proportions of patients with D-Dimer negative and correlations between coagulation parameters and platelets before and after age adjustment were statistically analyzed.Results There were no statistically significant differences in the baseline parameters between the 2 patient groups(P>0.05).The mean onset time for the fracture group was 6.7 days.The values of D-Dimer,FDP,PT,INR,TT and FIB in the fracture group were significantly higher than those in the degenerative disease group(P<0.001).After the D-Dimer threshold adjusted by age,75.71%(53/70)of the patients in the fracture group were negative while 98.57%(69/70)of those in the degenerative disease group were negative.Meanwhile,the values of D-Dimer and FDP showed a significant correlation(P<0.001)with a Pearson correlation coefficient of 0.932.Compared with the degenerative disease grou

关 键 词：骨质疏松 老年人 脊柱骨折 凝血 深静脉血栓 D-二聚体 

分 类 号：R68[医药卫生—骨科学]