Zhang Jianzheng, Chen Xiaobin, Wang Juan, Liu Zhi, Wang Xiaowei, Ren Jixin, Sun Tiansheng
Department of Orthopedic, Beijing Army General Hospital, Beijing, China.
Medicine (Baltimore). 2017 Sep;96(39):e8169. doi: 10.1097/MD.0000000000008169.
Choice of surgical approach in patients under clopidogrel treatment is controversial. Intertrochanteric fractures are common in the elderly, who also suffer from a number of comorbidities.The aim of this study is to assess the prognosis of elderly patients with clopidogrel treatment after surgery for intertrochanteric fracture.This was a cohort study of 238 elderly patients who underwent proximal femur intramedullary nailing for intertrochanteric fracture between January 2012 and December 2013 at the Geriatric Trauma Center of the Beijing Army General Hospital. The patients were divided into the clopidogrel (n = 32) and control (n = 206) groups according to their history of long-term clopidogrel treatment before surgery. Demographic and clinical characteristics, intraoperative parameters, postoperative complications, and 1-year survival were compared between the 2 groups.Preoperative American Society of Anesthesiologists (ASA) grade and the frequency of arterial stenting were different between the 2 groups (P = .002 and P < .001, respectively). The rate of intraoperative blood transfusion, ICU stay, and hospital stay were higher in the clopidogrel group compared with the control group (all P < .001). Postoperative complications were similar in the 2 groups. The 1-year mortality rate after surgery was significantly higher in the clopidogrel group compared with the control group (37.5% vs 20.3%, P = .030).Prognosis after surgery for intertrochanteric fracture was poorer in elderly patients with clopidogrel treatment; these patients had lower 1-year survival, more intraoperative blood transfusion, longer ICU stay, and longer hospital stay. ASA grade, arterial stenting, and anesthesia mode were prognostic factors.
接受氯吡格雷治疗的患者手术入路的选择存在争议。粗隆间骨折在老年人中很常见，而老年人还患有多种合并症。本研究的目的是评估老年粗隆间骨折患者术后接受氯吡格雷治疗的预后。
这是一项队列研究，研究对象为2012年1月至2013年12月在北京军区总医院老年创伤中心接受股骨近端髓内钉治疗粗隆间骨折的238例老年患者。根据术前长期服用氯吡格雷的病史，将患者分为氯吡格雷组（n = 32）和对照组（n = 206）。比较两组患者的人口统计学和临床特征、术中参数、术后并发症及1年生存率。
两组患者术前美国麻醉医师协会（ASA）分级和动脉支架置入频率不同（分别为P = 0.002和P < 0.001）。氯吡格雷组术中输血率、入住重症监护病房（ICU）时间和住院时间均高于对照组（均P < 0.001）。两组术后并发症相似。氯吡格雷组术后1年死亡率显著高于对照组（37.5%对20.3%，P = 0.030）。
接受氯吡格雷治疗的老年患者粗隆间骨折术后预后较差；这些患者1年生存率较低，术中输血较多，ICU停留时间较长，住院时间较长。ASA分级、动脉支架置入和麻醉方式是预后因素。
