活血通络汤预防人工股骨头置换后下肢深静脉血栓形成

背景：人工股骨头置换已经成为老年股骨转子间粉碎性骨折常用的治疗手段。但是，置换后深静脉血栓形成发生率一直居高不下，尤其多见于下肢。因而如何有效防治下肢深静脉血栓形成，成为医学界的热点问题。目的：观察活血通络汤对老年股骨转子间粉碎性骨折人工股骨头置换后下肢深静脉血栓形成的影响。方法：选择老年股骨转子间粉碎性骨折行人工股骨头置换患者38例，随机分为两组，即活血通络汤组和低分子肝素组，人工股骨头置换后分别给予活血通络汤内服和低分子肝素皮下注射，观察比较两组患者切口引流量、血小板计数及凝血酶原时间的变化，下肢血管彩色多普勒检查深静脉血栓形成情况。结果与结论：活血通络汤组患者切口引流量明显少于低分子肝素组(P < 0.05)；活血通络汤和低分子肝素对血小板计数影响差异无显著性意义；活血通络汤和低分子肝素均能明显的延长凝血酶原时间和部分凝血活酶时间，但低分子肝素效果优于活血通络汤(P < 0.05)；两组患者中各有2例轻度下肢深静脉血栓，两者在预防深静脉血栓形成方面效果相当。说明活血通络汤能够预防股骨转子间粉碎性骨折人工股骨头置换后深静脉血栓形成，其疗效同低分子肝素相当，且具有较好的安全性，值得临床推广应用。

Huoxue Tongluo decoction in the prevention of lower extremity deep venous thrombosis following femoral head prosthetic replacement in the elderly patients

BACKGROUND: Artificial femoral head replacement has been commonly used in femoral intertrochanteric fracture in elderly patients. However, the incidence of postoperative deep vein thrombosis is high, especially prevalent in the lower extremities. Therefore, how to prevent and treat lower extremity deep venous thrombosis effectively has become a hot issue in the medical profession.OBJECTIVE: To observe the effect of Huoxue Tongluo decoction on deep vein thrombosis following operation of comminuted femoral intertrochanteric fracture in elderly patients.METHODS: A total of 38 elderly patients with comminuted femoral intertrochanteric fracture undergoing artificial femoral head replacement were randomly divided into two groups: Huoxue Tongluo decoction and low molecular weight heparin (LMWH) groups, which was respectively treated with Huoxue Tongluo decoction and subcutaneous injection of LMWH. Incision drainage volume, change of platelet count and prothrombin time of the patients in two groups were observed and compared. Deep vein thrombosis was examined with lower extremity vascular color Doppler.RESULTS AND CONCLUSION: Incision drainage volume of Huoxue Tongluo decoction was less than the LMWH group (P < 0.05), but no differences were observed in platelet count between two groups (P > 0.05). Huoxue Tongluo decoction and LMWH significantly extended prothrombin time and partial thromboplastin time, but effect of LMWH was better than Huoxue Tongluo decoction (P < 0.05). There were both two cases of mild deep venous thrombosis in two groups, and Huoxue Tongluo decoction and LMWH played similar role in the prevention of deep venous thrombosis. Results show that Huoxue Tongluo decoction can prevent the occurance of lower extremity deep venous thrombosis after operation of comminuted femoral intertrochanteric fracture in elderly patients, and its efficacy is similar as LMWH. Moreover, it has good safety, and can be widely used in the clinic.