摘要
目的:观察不同手术方法对老年人股骨颈骨折术后下肢深静脉血栓形成(DVT)的影响,为选择性应用抗凝药物预防老年人股骨颈骨折术后下肢DVT提供依据。方法:180例老年新鲜股骨颈骨折患者均未应用药物进行预防性抗凝治疗,根据采取的手术方式不同分为3组:A组40例行闭合复位空心钉内固定术,B组68例行全髋关节置换术,C组72例行人工股骨头置换术。对术后出现患肢肿胀和(或)疼痛,伴有或不伴有Homans征/Neuhofs征阳性的患者常规应用加压超声技术行超声多谱勒检查以确定是否有下肢DVT。结果:超声多普勒显示A组阳性10例,DVT发病率为25.0%;B组阳性29例,1例阴性患者出院前猝死,尸检证实为伤肢混合型DVT并发肺栓塞,DVT发生率为44.1%;C组阳性20例,DVT发生率为27.8%。A组和C组DVT发生率低于B组(P<0.05),A组和C组DVT发生率比较差异无显著性(P>0.05)。结论:老年人股骨颈骨折行全髋关节置换术可能较闭合复位空心钉内固定术及人工股骨头置换术易发生下肢DVT。
Objective To investigate the effects of different surgical treatments on deep venous thrombosis （DVT） in the lower extremities of the old patients who underwent femoral neck fracture in order to provide basis for prevention of DVT with selective anticoagulant. Methods 180 old patients with new femoral neck fracture without any drug-anticoagulation therapy were divided into three groups according to different operative model. Group A： 40 cases were operated by closed reduction and internal fixation with hollow screws; group B： 68 cases were operated by replacement of total hip; group C： 72 cases were done by artificial femoral head replacement. Ultrasonic Doppler test was performed when swelling and/or pain, with or without Homans sign/Neuhofs sign were found positive in the operative legs. Results Doppler showed that 10 cases were positive in group A, the incidence of DVT was 25.0%; in group B 29 cases were positive, one case who was negative died for mixed DVT complicating pulmonary embolism in injuried extremity confirmed by autopsy prior to discharge, the incidence of DVT was 44.1% ; in group C 20 cases were positive, the incidence of DVT was 27.8%. The incidence of of DVT in group A and group C were lower than that in group B（ P〈0.05）, there was no significant difference between group A and group C. Conclusion The replacement of total hip may lead to a higher incidence of DVT, but the closed reduction and internal fixation with hollow screws and artificial femoral head replacement make a lower one in the old patients with femoral neck fracture.
出处
《吉林大学学报（医学版）》
CAS
CSCD
北大核心
2008年第1期150-152,F0003,共4页
Journal of Jilin University：Medicine Edition
基金
吉林省科技厅自然科学基金资助课题(2005166)
关键词
股骨颈骨折
深静脉血栓
下肢
老年人
femoral neck fracture
deep venous thrombosis
lower extremities
aged people
