股骨颈骨折对人工髋关节术后深静脉血栓形成影响的病例对照研究

目的:探讨股骨颈骨折是否为髋部人工关节术后DVT的危险因素。方法:检索自2005年1月至2010年7月于北京协和医院接受人工髋关节手术的患者,排除不适合纳入研究病例,其余为候选病例。候选病例均在术前经B超检查除外DVT,在围手术期接受了规范的预防DVT治疗。对术后出现DVT或肺栓塞(PE)症状、体征者,通过相应影像学检查进行确诊。选取术后发生症状性DVT的患者作为病例组,以年龄、性别、体重作为匹配条件选取对照组病例。在病例组和对照组中,以股骨颈骨折为暴露因素,计算比值比(OR)并比较其暴露率,验证其关联强度。结果:在670例接受人工髋关节手术的患者中,408例为候选病例。其中13例术后发生症状性DVT作为病例组,男4例,女9例,平均年龄77岁(57～91岁),全部为股骨颈骨折患者。对照组52例中男18例,女34例,平均年龄76.98岁(57～91岁);其中39例因股骨颈骨折接受手术。病例组中股骨颈骨折的暴露率为100%(13/13),对照组为75%(39/52),2组暴露率差异无统计学意义。结论:尚不能认为股骨颈骨折是髋部人工关节术后症状性DVT的独立危险因素。股骨颈骨折的流行病学特征决定了其患病人群既是DVT的高危人群,也是接受人工髋关节手术的主要人群。人工髋关节手术可以降低股骨颈骨折的DVT风险,与手术本身的DVT风险增加相平衡,故股骨颈骨折患者术后DVT风险较非股骨颈骨折患者并未显著升高。

Case-control study on influence of femoral neck fracture on deep venous thrombosis in patients undergoing prosthetic hip surgery

Objective:To investigate the association between femoral neck fracture and deep vein thrombosis(DVT) in patients undergoing prosthetic hip surgery. Methods:The data of patients who underwent prosthetic hip surgery from January 2005 to July 2010 were collected,the cases were included into the study after exclusion of those could not be suitable for the study. The patients with diagnosis of deep-vein thrombosis(DVT) were identified together as the case group,and the patients without DVT were selected randomly and matched with frequency as the control group. The matching characteristics included age,gender and body weight. The patients with femoral neck fracture were counted in both case and control group. The odds ratio was calculated and the exposure rate of both group were compared. Results:There were total 670 patients underwent prosthetic hip surgery during the period,and after exclusion,the data of 408 patients were collected into the study. There were 13 patients in the case group(4 males and 9 females,ranging in age fram 57 to 91 years),all of them suffering from femoral neck fracture and the exposure rate was 100.0%(13/13). There were 52 patients in the control group(18 males and 34 females,ranging in age from 57 to 91 years),39 of them suffering from femoral neck fracture,the exposure rate was 75.0%(39/52);there was no statistically significant difference in exposure rate of two groups. Conclusion:The diagnosis of femoral neck fracture is not the independent risk factor for postoperative DVT of prosthetic hip surgery. The epidemiologic characteristics of femoral neck fracture indicate that the patients are in high risk of DVT,who meanwhile are the most of patients undergoing the prosthetic hip surgery. Though the surgery itself is a risk of DVT,it can reduce the risks for patients with femoral neck fracture through some therapeutic effects.