Sa-Ngasoongsong Paphon, Kulachote Noratep, Sirisreetreerux Norachart, Chanplakorn Pongsthorn, Laohajaroensombat Sukij, Pinsiranon Nithiwut, Woratanarat Patarawan, Kawinwonggowit Viroj, Suphachatwong Chanyut, Wajanavisit Wiwat
Paphon Sa-ngasoongsong, Noratep Kulachote, Norachart Sirisreetreerux, Pongsthorn Chanplakorn, Sukij Laohajaroensombat, Nithiwut Pinsiranon, Patarawan Woratanarat, Viroj Kawinwonggowit, Chanyut Suphachatwong, Wiwat Wajanavisit, Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
World J Orthop. 2015 Dec 18;6(11):970-6. doi: 10.5312/wjo.v6.i11.970.
To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture (FNF) and taking concomitant antiplatelet agents.
Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery (ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics (45 cases) who had delayed surgery (DS group) after 72 h during an earlier 3-year period. Postoperative outcomes were followed for one year and compared.
There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality (P > 0.05 all). There were 2 patients (4%) in the DS group who died after surgery (P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome (P < 0.05 all).
Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.
探讨早期手术干预对高龄且手术风险高、发生股骨颈骨折（FNF）并正在服用抗血小板药物患者的影响。
2010年至2012年，对49例服用抗血小板药物、发生FNF并在72小时内接受手术的老年患者进行了前瞻性研究[早期手术（ES）组]，并将其与一组回顾性连续病例系列（45例）进行比较，该系列患者具有相似特征，在更早的3年期间于72小时后接受了延迟手术（DS组）。对术后结果进行了为期一年的随访并比较。
围手术期失血量、输血情况、重症监护病房需求和术后死亡率方面无显著差异（均P>0.05）。DS组有2例患者（4%）术后死亡（P = 0.23）。然而，ES组在术后并发症、住院时间和功能结局方面术后结果明显更好（均P<0.05）。
正在接受抗血小板治疗的老年髋部骨折患者早期进行髋关节手术与围手术期失血量和术后死亡率的显著增加无关。此外，早期手术导致更好的术后手术结果。在早期髋关节手术方案中，停用抗血小板药物，患者在入院后72小时内接受手术，这对身体状况良好的患者是安全有效的。
