老年股骨颈骨折患者关节置换术前深静脉血栓形成的发生率

目的 探讨老年股骨颈骨折患者关节置换术前深静脉血栓形成(DVT)的发生情况. 方法 2007年1月至9月收治175例Garden Ⅲ、Ⅳ型老年股骨颈骨折患者,均拟行关节置换术,其中男51例,女124例;年龄60～90岁,平均73.5岁.术前不同时间接受双下肢静脉彩超检查以筛查DVT.彩超检查时探头的压迫不能使静脉管腔塌陷是诊断DVT的主要标准. 结果除去6例明显延迟就诊(＞2周)患者外,其余169例患者骨折发生至超声检查的等待时间平均为4.6 d(3～6d).本组DVT的总发生率为18.3%(32/175).骨折后第3～6天检测的DVT发生率分别为13.3%(4/30)、20.4%(10/49)、19.6%(10/51)、17.9%(7/39),6 d后的DVT发生率为16.7%(1/6).男性组DVT发生率为17.6%(9/51),女性组为18.5%(23/124).60～69岁组DVT发生率为15.7%(8/51),70～79岁组为18.7%(17/91),≥80岁组为21.2%(7/33).以骨折发生至超声检查时间、性别、患者年龄为分组依据分别进行比较,各组间DVT发生率差异均无统计学意义(P值分别为0.950、0.889、0.807). 结论老年股骨颈骨折患者等待关节置换手术期间有较高的DVT发生率,超过48 h的患者应常规术前筛查并采取相应预防措施以降低围手术期风险.

Incidence of deep venous thrombosis in elderly patients with femoral neck fracture before arthroplasty

Objective To report the incidence of deep venous thrombosis (DVT) in elderly patients with femoral neck fracture before arthroplasty. Methods From January 2007 to September 2007, 175 (51 male and 124 female) elderly patients with femoral neck fracture of Garden type Ⅲ or Ⅳ were admitted in our department. They had a median age of 73.5 years (range, 60 to 90 years). At different time points before hip arthroplasty, they had venous color Doppler ultrasonography in their bilateral lower limbs to screen DVT.The main ultrasonic criterion for diagnosis of DVT was the failure of the vascular lumen to collapse under the probe pressure. All the DVT-related data were collected. Results The mean interval from fracture to ultrasonography was 4.6 days (range, 3 to 6 days) for all but 6 patients who had much delayed medical attention (＞ 2 weeks). In this series the overall incidence of DVT was 18. 3% (32/175). The DVT incidence for patients examined from 3 to 6 days after fracture was respectively 13. 3% (4/30), 20.4% (10/49),19. 6% (10/51), and 17.9% (7/39), but dropped to 16. 7% (1/6) for those examined over 6 days after fracture. The incidence of DVT was 17. 6% (9/51) in men and 18.5% (23/124) in women. The DVT occurrence was 15. 7% (8/51) in patients aged 60 to 69 years, 18. 7% (17/91) in those aged 70 to 79 years and 21.2% (7/33) in those aged over 80 years. No statistically significant deference was found to be associated with interval from fracture to ultrasonography, age and gender in this study(P ＞ 0. 05). Conclusions The elderly patients with femoral neck fracture may have a high incidence of DVT before arthroplasty. For patients who are to have arthroplasty beyond 48 hours after fracture, ultrasonography should be performed to detect DVT in the lower limbs and prophylaxis should be taken to reduce their perioperative risk.