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髋部骨折患者静脉血栓栓塞症诊断与预防的最新进展

Recent Updates of the Diagnosis and Prevention of Venous Thromboembolism in Patients with a Hip Fracture.

作者信息

Shin Won Chul, Lee Sang Min, Suh Kuen Tak

机构信息

Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.

出版信息

Hip Pelvis. 2017 Sep;29(3):159-167. doi: 10.5371/hp.2017.29.3.159. Epub 2017 Sep 6.

Abstract

Venous thromboembolism (VTE) is a potentially fatal complication that is relatively common after hip surgery. Since patients with a hip fracture have a higher risk of preoperative VTE due to an inability to ambulate after injury and aggravation of underlying age-related conditions, it may be difficult to effectively prevent VTE using only conventional approaches. Very few studies have been published reporting on the prevalence and prevention of VTE in patients with a hip fracture compared to those with hip arthroplasty. For this reason, we aimed to share recent updates on the diagnosis and prevention of VTE in patients with a hip fracture. Preoperative screening tests to diagnose VTE need to be performed more actively following hip fracture and indirect multidetector computed tomography venography is considered the most effective test for this purpose. As the risk of VTE appears to increase with time following a hip fracture, preventive measures should be taken as soon as possible in patients with a hip fracture. A wide variety of mechanical and pharmacological options are available for prophylaxis. When considering patient compliance and preventive impact, intermittent pneumatic compression devices and foot pumps are recommended as mechanical modalities. Of the available preventive medications for patients with a hip fracture, low molecular weight heparin seems to be the most appropriate option because of its short half-life and fast onset of action. Surgery should be performed as soon as possible in patients with hip fractures, and we recommend mechanical and pharmacological methods as active interventions immediately after injury to prevent VTE.

摘要

静脉血栓栓塞症(VTE)是一种潜在致命的并发症,在髋关节手术后相对常见。由于髋部骨折患者因受伤后无法行走以及潜在的与年龄相关疾病的加重而术前发生VTE的风险较高,仅使用传统方法可能难以有效预防VTE。与髋关节置换术患者相比,关于髋部骨折患者VTE的患病率和预防的研究报道极少。因此,我们旨在分享髋部骨折患者VTE诊断和预防的最新进展。髋部骨折后需要更积极地进行术前筛查以诊断VTE,间接多层螺旋CT静脉造影被认为是为此目的最有效的检查。由于髋部骨折后VTE风险似乎随时间增加,对于髋部骨折患者应尽快采取预防措施。有多种机械和药物预防选择。考虑到患者依从性和预防效果,推荐间歇充气加压装置和足部泵作为机械方式。对于髋部骨折患者,在可用的预防性药物中,低分子量肝素似乎是最合适的选择,因为其半衰期短且起效快。髋部骨折患者应尽快进行手术,我们建议在受伤后立即采用机械和药物方法作为积极干预措施以预防VTE。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8883/5612975/096fed3d9619/hp-29-159-g001.jpg

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