服用氯吡格雷的老年髋部骨折患者尽早手术的安全性研究

目的:探讨服用氯吡格雷的老年髋部骨折患者尽早手术的安全性。方法:回顾性分析2016年11月至2017年4月期间北京积水潭医院创伤骨科连续收治的242例老年髋部骨折患者资料。将服用氯吡格雷且停药4 d以内手术患者纳入研究组，共20例，年龄中位数为80（77,81）岁；男6例，女14例。手术方式：股骨颈骨折空心钉固定2例，...

Safety of early hip fracture surgery for elderly patients on clopidogrel

Objective To investigate the safety of early hip fracture surgery for elderly patients on clopidogrel.Methods This retrospective study included 242 consecutive elderly patients(≥65 years)with acute hip fracture who had undergone surgery at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital between November 2016 and April 2017.Of them,20 were assigned into the study group who had taken clopidogrel before injury but discontinued its use within 4 days before surgery.They were 6 males and 14 females,with a median age of 80 years(77,81).Their operation procedures for hip fracture included internal fixation with cannulated screws for femoral neck fracture in 2 cases,hemiarthroplasty for displaced femoral neck fracture in 11 cases,and internal fixation for intertrochanteric fracture in 7 cases.The control group included 222 patients who had undergone the same operative procedures but not taken any antiplatelet or anticoagulant drugs.The 2 groups were compared in terms of time between admission and operation,operation duration,intraoperative blood loss,perioperative transfusion and complications related to bleeding to analyze the safety of early surgery.Results There was no significant difference in the preoperative general data between the 2 groups,showing comparability(P>0.05).There was no significant difference between the 2 groups in the time between admission and operation[42.5(36.3,48.0)h for the study group versus 43.0(28.0,61.0)h for the control group](P=0.870).The median time between the last use of clopidogrel and operation was 55.0(30.5,71.0)h.There were no significant differences between the 2 groups in preoperative hemoglobin,operation duration,intraoperative blood loss,rate or amount of perioperative blood transfusion,or rate or amount of wound drainage(P>0.05).The rate of general anesthesia was significantly higher for the study group(45.0%,9/20)than for the control group(18.5%,41/222)(P=0.012).No complications related to spinal hematoma occurred in the patients receiving spinal anesthesia from the study group.Wound hematoma and subsequent infection occurred in 2 patients from the control group.Conclusion Early hip fracture surgery is safe for elderly patients on clopidogrel.