摘要
目的 探讨按《中国骨科大手术静脉血栓栓塞症预防指南》（简称《指南》）预防人工髋关节置换术后静脉血栓栓塞症（VTE）的有效性和出血并发症的风险. 方法 2001年1月至2005年1月对402例患者行人工髋关节置换术,男119例,女283例 平均年龄63.2岁 其中股骨颈骨折278例,股骨头缺血性坏死78例,骨关节炎46例,没有按〈指南〉进行规范预防（A组） 2009年1月至2010年1月对120例患者行人工髋关节置换术,男36例,女84例 平均年龄62.9岁 其中股骨颈骨折83例,股骨头缺血性坏死23例,骨关节炎14例,按〈指南〉实施基本预防措施和物理预防措施,药物预防于术后12 h开始皮下注射低分子量肝素至术后10 d,之后改用口服利伐沙班至术后21 d（B组）.比较两组患者发生症状性VTE和出血并发症的比例. 结果 A组出现下肢深静脉血栓形成（DVT）83例,发生率为20.6%（83/402） 出血并发症28例（7.0%,28/402）.B组15例出现DVT,发生率为12.5%（15/120） 出血并发症8例,发生率为6.7%（8/120）.B组DVT的发生率低于A组,差异有统计学意义（χ2=4.022,P=0.045）.两组出血并发症发生率差异无统计学意义（χ2=0.002,P=0.960）. 结论按照〈指南〉对人工髋关节置换术患者术后VTE进行预防,提高了预防效果,同时不会增加出血的风险.
Objective To evaluate the efficacy and safety of Chinese Orthopedic Association Guidelines for Prevention of Venous Thromboembolism used for patients undergoing hip replacement.Methods A comparison was made between patients whose management was not guided by Chinese Orthopedic Association Guidelines for Prevention of Venous Thromboembolism （groups A） and those whose management was guided （group B）. In group A, there were 402 patients undergoing hip replacement from January 2001 to January 2005. They were 119 men and 283 women, with a mean age of 63. 2 years. There were 278femoral neck fractures, 78 cases of ischemic necrosis of femoral head and 46 cases of hip osteoarthritis. In group B, there were 120 patients undergoing hip replacement from January 2009 to January 2010. They were 36 men and 84 women, with a mean age of 62. 9 years. There were 83 femoral neck fractures, 23 cases of ischemic necrosis of femoral head and 14 cases of hip osteoarthritis. Events of venous thromboembolism and bleeding complications were recorded in each group for statistical comparison. Results In group A, 83cases （20. 6%） of deep venous thrombosis and 28 cases （7.0%） of bleeding complication were found. In group B, 15 cases （12. 5%） of deep venous thrombosis and 8 （6. 7%） cases of bleeding complication occurred. There were statistically significant differences between the 2 groups in incidence of venous thrombocmbolism （χ2 = 4. 022, P = 0. 045）, but not in incidence of bleeding complications （χ2 = 0. 002, P =0. 960） . Conclusion It is more effective and safer to perform hip replacement under the guidance of Chinese Orthopedic Association Guidelines for Prevention of Venous Thromboembolism.
出处
《中华创伤骨科杂志》
CAS
CSCD
2010年第12期1115-1118,共4页
Chinese Journal of Orthopaedic Trauma
关键词
关节成形术
置换
髋
静脉血栓形成
预防医学
Arthroplasty, replacement, hip Venous thrombosis Preventive medicine
