弹力绷带加压包扎联合低分子肝素预防老年人股骨转子间骨折术后深静脉血栓形成的疗效观察  

Effect of elastic bandage combine low molecular weight heparin on deep venous thrombosis after intertrochanteric fracture surgery in the elderly

作　　者：王志猛 路遥[2] 马腾[2] 李忠[2] 张堃[2] 杨娜[2] 田丁[2] WANG Zhi⁃meng;LU Yao;MA Teng;LI Zhong;ZHANG Kun;YANG Na;TIAN Ding(Xi'an Medical College,Xi'an 710068;Department of Orthopaedics,Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安医学院,西安710068 [2]西安交通大学医学院附属红会医院创伤骨科,西安710054

出　　处：《骨科》2020年第1期35-38,50,共5页ORTHOPAEDICS

基　　金：陕西省自然科学基金(2017ZDXM-SF-009)

摘　　要：目的探讨弹力绷带加压包扎联合低分子肝素(low molecular weight heparin, LMWH)预防老年人股骨转子间骨折术后下肢深静脉血栓形成(deep vein thrombosis, DVT)的疗效。方法回顾性分析西安交通大学医学院附属红会医院创伤骨科2016年3月至2018年1月收治的150例老年股骨转子间骨折病人的临床资料,所有病人手术前后均使用LMWH抗凝预防血栓形成,根据术后是否使用弹力绷带加压包扎分为观察组和对照组。观察组72例,其中男29例,女43例,年龄为(75.83±7.01)岁(65~87岁)。对照组78例,其中男30例,女48例,年龄为(74.77±7.55)岁(65~89岁)。病人骨折部位均采用闭合复位股骨近端防旋髓内钉治疗,术后第1、3、5天行双下肢静脉B超检查(观察组拆除弹力绷带后行双下肢静脉B超检查),记录并比较两组的DVT发生率及并发症情况。结果两组病人术后第1、3、5天的DVT发生率比较,差异均无统计学意义(P均>0.05);观察组共发生DVT 8例,发生率为11.11%,对照组19例发生DVT,发生率为24.36%,两组DVT总发生率比较,差异有统计学意义(χ^2=4.452,P=0.035);两组间术后下肢肿胀、皮下瘀斑、注射LMWH部位血肿发生率的差异均无统计学意义(P均>0.05)。结论弹力绷带加压包扎双下肢联合LMWH可降低老年股骨转子间骨折术后DVT发生率,简单、易行,值得临床推广。Objective To investigate the efficacy of elastic bandage combined with low molecular weight heparin(LMWH) in prevention of deep vein thrombosis(DVT) after proximal femoral nail antirotation(PFNA) in elderly patients with intertrochanteric fractures.Methods A retrospective analysis of 150 elderly patients with intertrochanteric fractures from March 2016 to January 2018 in Xi conducted,and all patients were treated with LMWH anticoagulation to prevent thrombosis.According to whether the elastic bandage was used after surgery,the patients were divided into experimental group and control group.There were 29 males and 43 females in the experimental group,with age of(75.83±7.01) years old(65-87 years old).There were 30 males and 48 females in the control group,with age of(74.77±7.55) years old(65-89 years old).The fracture sites of all patients were treated with PFNA.B-ultrasound was performed on both lower limbs at 1st,3rd and 5th day after operation(experimental group undergoing the B-ultrasound after the elastic bandage was removed).The incidence of DVT and complications in the two groups were observed and compared.Results There was no significant difference between two groups in the incidence of DVT at 1st,3rd and 5th day after operation(P>0.05).In the experimental group,8 cases had DVT with the incidence rate being 11.11%,and 19 cases in the control group with the incidence rate being 24.36%(P<0.05).There was no significant difference in swelling rate of the lower limbs,subcutaneous ecchymosis and hematoma at LMWH injection site between the two groups(P>0.05).Conclusion Elastic bandages compressed combined with LMWH can significantly reduce the rate of postoperative DVT in elderly patients with intertrochanteric fractures.The method is simple and valuable to clinical application.

关 键 词：股骨转子间骨折 深静脉血栓形成 弹力绷带 加压包扎 

分 类 号：R687.3[医药卫生—骨科学]