综合防治法预防高龄股骨近端骨折下肢深静脉血栓形成82例

下肢深静脉血栓形成（deep venous thrombosis,DVT）是高龄患者手术后常见并发症,尤其是重症颅脑外伤、开颅手术、下肢骨折、盆腔手术后。由于可并发致命性肺梗死及远期肺功能不全、深静脉功能不全等而严重威胁着患者的健康。2005年7月—2009年5月我院采取综合干预治疗65岁以上股骨近端骨折患者82例,报道如下。     

弹性压迫预防下肢深静脉血栓形成的评价

深静脉血栓形成（DVT）多发生于下肢,大多在手术中和手术后数日内起病,术后5—9天发病者仅占10％左右。由于DVT发病初期可并发肺梗塞,长期后又可演变为血栓后遗症,即使再通后又能造成深静脉瓣膜功能不全,出现一系列;临床症状和体征,严重影响患者的生活和工作的质量和能力,固此DVT一直受到学者们的关注,是目前国内外外科领域中的难题之一。     

下肢骨折合并深静脉血栓形成的诊治

深静脉血栓(DVT)是外科创伤后的一种并发症,尤以髋膝部骨折后最常见。如处理不当,可继发致命性肺栓塞、截肢或远期下肢深静脉功能不全。本院自1999年9月至2006年12月,收治9例下肢骨折并发DVT病人,经过早期诊断及时治疗,效果满意。现报告如下。     

下肢骨折术后预防深静脉血栓形成的护理方法探讨

目的 对下肢骨折术后预防下肢深静脉血栓形成(deep venous thrombosis DVT)采用常规的护理措施、DVT的预防护理方式进行研究,比较具体效果.方法 选取2018年1月—2021年6月行下肢骨折术治疗的64例患者,采用随机数字表法分为对照组(n=32)组和观察组(n=32).分别采用常规护理模式和DV...     

下肢深静脉血栓形成的研究现况

下肢深静脉血栓形成 (ＤＶＴ)多由手术、外伤、分娩和严重心脑疾病等引起 ,是常见的多发病。 2 0世纪 80年代 ,据Ｃｌａｇｅｔｔ等[1] 报道 ,外科大手术未采取预防措施者 ,ＤＶＴ的发病率为 2 5 %。在ＤＶＴ起病 2～ 3周的急性期内 ,患肢肿胀、胀痛 ,并可能并发肺栓塞 (ＰＥ) ,重者可以致命。大多数ＤＶＴ患者虽经治疗 ,但血栓未能完全消融 ,而转为血栓形成后遗症。再通不完全者 ,临床表现为各种程度不同的回流障碍病变 ;完全再通者 ,则因深静脉瓣膜悉遭破坏 ,酿成血液倒流性病变。两者都将导致下肢静脉系统郁血和高压症 ,严重影响生活质量…     

椎管内麻醉对老年股骨粗隆间骨折术后恢复及下肢深静脉血栓形成的影响

目的 探讨椎管内麻醉对老年股骨粗隆间骨折术后恢复及下肢深静脉血栓(DVT)形成的影响。方法 收集2021年6月至2023年3月于首都医科大学附属北京积水潭医院进行手术治疗的126例老年股骨粗隆间骨折患者的临床资料,按照麻醉方式的不同将患者分为椎管内麻醉组(n=61)和全身麻醉组(n=65)。比较两组患者的手术相关指标以及术后住院期间下肢DVT、谵妄、感染、出血的发生率。结果 两组患者的骨折至手术时间、手术时间、术中出血量、术中低体温的比例、使用骨水泥的比例、使用低分子肝素的比例、穿弹力袜的比例比较,差异均无统计学意义(P﹥0.05)。术后住院期间,椎管内麻醉组患者下肢DVT、谵妄、感染的发生率均低于全身麻醉组患者,差异均有统计学意义(P﹤0.05);两组患者出血的发生率比较,差异无统计学意义(P﹥0.05)。结论 椎管内麻醉可降低老年股骨粗隆间骨折术后下肢DVT、谵妄及感染的发生率,同时未增加术后出血风险。     

四通胶囊预防下肢骨折术后深静脉血栓形成的临床研究

[目的]研究四通胶囊在预防下肢骨折术后深静脉血栓(DVT)形成中的作用.[方法]下肢骨折手术患者240例.其中80例患者行四通胶囊口服治疗10 d,80例应用低分子肝素钠皮下注射10 d,80例患者纳入空白对照组.定期采用下肢彩色多普勒检查,凝血酶原时间检查并记录患肢情况.[结果]接受四通胶囊治疗的患者中仅4例发现深静脉血栓,无1例出现凝血酶原时间异常;接受低分子肝素钠治疗的患者中8例发现深静脉血栓,但因出现凝血酶原时间延长而停止治疗的患者有11例.空白对照组治疗的患者有28例发现深静脉血栓.组间差异显著(P<0.01).[结论]四通胶囊对下肢骨折术后DVT的发生具有预防作用.     

老年髋部骨折术前下肢深静脉血栓形成的影响因素研究

[目的]初步探讨老年髋部骨折患者术前发生下肢深静脉血栓(DVT)的概率及其患病的相关危险因素。[方法]回顾性分析2016年7月~2016年12月收入我院的老年髋部骨折患者323例,按其是否发生下肢DVT分为DVT组和无DVT组。分别收集患者的性别、年龄、受伤至接受检查的时间、骨折类型、体重指数(BMI)、高血压、糖尿病、冠心病、肺部疾病、脑血管病、肿瘤、老年痴呆、肝肾疾病、周围血管疾病以及高脂血症等一般临床资料,所有入组患者均采用Charlson合并症指数(CCI)评分评估患者的内科基础状况。[结果]本研究中老年髋部骨折术前发生DVT的概率为10.84%。经单因素对比分析显示DVT组患者受伤至接受检查的时间和CCI评分明显高于无DVT组,并且具有更高的糖尿病、肺部疾病、脑血管病、肝肾疾病、周围血管疾病及高脂血症患病率(P<0.05)。进一步对差异显著的因素进行多因素Logistic回归分析显示受伤至接受检查的时间、脑血管病、周围血管病、高脂血症以及CCI是发生DVT的危险因素(P<0.05)。[结论]老年髋部骨折患者在术前具有较高的下肢DVT发生率,因此在术前均需对下肢DVT进行筛查;并且对术前等待时间较长、合并脑血管病、周围血管疾病、高脂血症及CCI较高的患者应特别警惕下肢DVT的发生。     

下肢骨折病人预防深静脉血栓形成的原因与护理

骨科下肢骨折患者由于长期卧床及肢体制动,易造成肌肉的废用性萎缩,肌泵的力量减弱,引起局部静脉、淋巴管回流障碍,血流缓慢形成血栓,甚至危及病人的生命,应引起医务人员的高度重视.     

PROPHYLAXIS AGAINST VENOUS THROMBOSIS AFTER TOTAL HIP ARTHROPLASTY

Venous thrombosis rates were compared in 200 patients undergoing total hip arthroplasty and randomized to receive either fixed mini-dose warfarin (1 mg daily) or adjusted-dose warfarin to maintain an international normalized prothrombin ratio (INR) of 2.0–4.0. Bilateral lower limb venography was performed between days 11 and 13 inclusive. Fixed mini-dose warfarin was associated with a significantly higher rate of total thrombosis (P < 0.05). General anaesthesia was associated with a significantly higher rate of thrombosis than spinal anaesthesia (P < 0.05). Adjusted-dose warfarin was associated with more bleeding complications than mini-dose warfarin although these were not attributable to excessive anticoagulation. A single death from pulmonary embolus occurred in the early postoperative period in a patient receiving adjusted-dose warfarin.     

周期性充气加压预防下肢手术后深静脉血栓

目的 探讨单独使用周期性充气加压（ＩＰＣ）预防下肢手术后深静脉血栓（ＤＶＴ）的效果。方法１９９７年１０月￣１９９８年８地４０例下肢手术患者使用ＩＰＣ预防ＤＶＴ。其中人工全髋关节置换术２４例,髋滑动加压鹅头钉术１２例,人工全膝关节表面置换术４例。术前超声多普勒证实双下肢无ＤＶＴ,术后开始使用ＩＰＣ,术后当天持续使用ＩＰＣ８小时,术后第１天起每隔６小时使用ＩＰＣ一次,每次２小时,直至出院,整个疗程至少     

股骨近端钉治疗老年股骨粗隆间骨折

目的探讨股骨近端钉(proximalfemoralnail,PFN)治疗老年股骨粗隆间骨折的疗效。方法2001年10月~2003年9月,采用PFN治疗老年股骨粗隆间骨折患者62例,其中男42例,女20例。年龄60~92岁,平均67.3岁。均在伤后1周内施行手术。记录每例患者的手术时间、术中出血量、术中并发症、术后切口引流量、术后并发症、骨折愈合时间及髋关节功能评分等相关数据,并与文献进行比较,对该治疗方法进行评价。结果术后均随访8~22个月,平均13.6个月。2例发生术中股骨粗隆骨折部再骨折,2例术后分别死于脑栓塞和肺部感染,2例发生异位骨化,1例发生髋内翻,1例发生股骨头过度前倾,其余患者皆获满意疗效。手术时间76.5±29.1min,术中平均出血量385.7±98.4ml,术后切口引流量45.5±21.7ml,骨折愈合时间13.2±3.8周;参照Sanders髋关节创伤后的功能评分标准,术后髋关节功能恢复优良率达89.6%。结论PFN具有手术时间短、出血少且固定牢靠的优点,适用于老年股骨粗隆间骨折的治疗。     

OUTCOME AFTER FRACTURES OF THE FEMUR IN PAGET'S DISEASE

We reviewed ninety-three patients who had one hundred and seven complete fractures of the femur between them and were treated over a twenty-five year period in Western Australia and South Australia. Operative surgical management of complete fractures in the middle and distal thirds was usually successful. In contrast, fractures proximal to the middle third were regularly associated with non-union, implant failure and requirement for revision surgery. In view of this significant difference in outcome after fracture of the pagetic femur in different sites, a comprehensive surgical management strategy is recommended in order to avoid complications.     

手术与非手术治疗老年肱骨近端复杂骨折疗效比较

目的比较手术与非手术治疗老年肱骨近端三、四部分骨折的疗效。方法 2009年1月-2011年1月,收治35例肱骨近端三、四部分骨折老年患者。其中20例行切开复位、锁定钢板内固定治疗(手术组),15例行闭合复位、夹板或石膏外固定(非手术组)。两组患者性别、年龄、病因、骨折分型及病程等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。两组治疗后均行正规功能锻炼。结果手术组患者术后切口均Ⅰ期愈合。两组患者均获随访,随访时间12～20个月,平均16个月。X线片检查示,除手术组1例(5.0%)骨折不愈合,其余患者骨折均愈合。手术组2例(10.0%)、非手术组1例(6.7%)发生内翻畸形,手术组1例(5.0%)、非手术组1例(6.7%)发生肱骨头缺血性坏死。两组以上并发症发生率比较,差异均无统计学意义(P>0.05)。末次随访时,手术组与非手术组肩关节功能Constant-Murley评分分别为(66.8±11.8)分及(64.7±9.9)分,比较差异无统计学意义(t=0.59,P=0.47)。结论手术与非手术治疗老年肱骨近端三、四部分骨折疗效相似,对手术风险高、日常活动要求低或拒绝手术治疗的老年患者可选择非手术治疗。     

低分子肝素预防髋膝关节术后下肢深静脉血栓形成

目的 评价低分子肝素预防髋、膝关节术后深静脉血栓形成（DVT）的疗效和安全性。方法 1997年4月－1998年10月选择接受髋、膝周围手术的患者46例均为40岁以上,3个月内无血栓栓塞性疾病史、无凝血功能障碍,术前经彩色多普勒超声法筛查,双下肢无DVT,随机分成两组。预防组应用低分子肝素（速避凝）预防DVT,对照组不采用任何预防措施。术后第4－7天行患侧静脉造影,了解深静脉血栓的发生情况。结果 对照组中8例发生DVT,占34．8％;预防组中1例发生DVT,占4．3％。经统计学处理有显著性差异（P＜0．05）。两组均未发生明显的出血并发症。结论 低分子肝素能安全、有效地预防髋膝关节术后深静脉血栓形成。     

HOW TO PREDICT RETURN TO THE COMMUNITY AFTER FRACTURED PROXIMAL FEMUR IN THE ELDERLY

Background : There are numerous studies about morbidity and mortality, technical complications and in-hospital factors after proximal femoral fracture surgery in the elderly. Although experienced clinicians are often able to make an accurate prediction, little information is available about the factors that allow early determination of whether a patient may return to the community. The present study aimed to provide that information and, hence, allow better use of health resources. Methods : At Westmead Hospital a prospective study was conducted of 304 patients with a proximal femoral fracture who were previously residing at home. A number of different factors were analysed using statistical methods to determine their effect on outcome, which was defined simply in terms of whether the patient was able to return to the community or whether they needed institutional care. Results : Factors that had an adverse influence on return to the community were: a low activities of daily living (ADL) score on admission; increasing age; dementia; the use of regional analgesia; and the occurrence of postoperative complications. Other factors such as gender, fracture type, delay to surgery and length of stay were not significant. Conclusions : Consideration of the ADL score, age and mental state at the time of admission to hospital is all that is needed to determine return to the community. This is helpful to the patient and their family, and allows an early and appropriate referral pattern to either community services or a nursing home.     

DEEP VEIN THROMBOSIS PROPHYLAXIS: A SURVEY OF CURRENT PRACTICE IN AUSTRALIA AND NEW ZEALAND

A survey of current practice for deep vein thrombosis (DVT) prophylaxis was undertaken in Australia and New Zealand. The most common indications for prophylaxis were a history of thrombo-embolism, the type and length of surgery and obesity. Prophylaxis was used in 65% of patients having hip surgery and in 39% undergoing knee surgery. In general surgery the corresponding rate was around 67% for colorectal surgery, hepatobiliary, upper gastrointestinal and major abdominal vascular surgery. Apart from open-heart cardio-thoracic surgery (66%), use in other specialties was less than 50%. Physical methods (anti-embolism stockings, calf stimulation and calf compression devices) were most commonly used for prophylaxis (46%) with heparin being used by 40%. The main side effect reported with heparin was bleeding (18%). The estimated incidence of DVT and pulmonary embolus (PE) was 2.8 and 0.4% for general surgery, 2.7 and 0.7% for orthopaedic surgery and 6.6 and 1.3% for hip surgery. Intravenous heparin followed by oral anticoagulants was the most commonly used treatment for established DVT and nearly all respondents used intravenous heparin and oral anticoagulants for treatment of PE. Venography was the favoured objective test for diagnosing DVT. The principal reason for considering a change in prophylactic policy was the potential availability of an agent with increased efficacy and a reduced incidence of haemorrhagic complications.