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,股骨颈骨折股骨头置换11例,股骨转子间骨折内固定7例。将未服用抗凝、抗栓药且手术方式与研究组一致的患者纳入对照组(222例)。比较两组患者的入院至手术时间、手术时间、术中出血量、围手术期输血量和出血相关并发症等,分析尽早手术的安全性。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。研究组患者的入院至手术时间为42.5(36.3,48.0)h,与对照组患者43.0(28.0,61.0)]比较差异无统计学意义(P=0.870)。研究组患者末次服用氯吡格雷至手术时间为55.0(30.5,71.0)h。两组患者的术前血红蛋白、手术时间、术中出血量、输血比例、输血量、切口引流放置比例、引流量等方面比较差异均无统计学意义(P>0.05)。研究组患者的全身麻醉比例(45.0%,9/20)显著高于对照组患者(18.5%,41/222),差异有统计学意义(P=0.012)。研究组椎管内麻醉患者均未发现椎管内出血的相关并发症。术后3个月内对照组2例患者出现切口血肿、继发感染。结论服用氯吡格雷的老年髋部骨折患者,停用氯吡格雷后可以尽早手术。

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 operation42.5(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.