Jang Chul-Young, Kwak Dae-Kyung, Kim Dae-Hwan, Lee Hyung-Min, Hwang Ji-Hyo, Yoo Je-Hyun
Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 431-070, Republic of Korea.
Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
BMC Musculoskelet Disord. 2019 Mar 25;20(1):124. doi: 10.1186/s12891-019-2504-5.
Antiplatelet medication has been frequently performed in elderly patients with hip fracture, because of comorbidities. This observational cohort study was to evaluate the effect of continuous perioperative antiplatelet medication on the outcomes after cephalomedullary nailing (CMN) in elderly patients with a proximal femur fracture.
One hundred and sixty-two consecutive patients aged ≥70 years undergoing CMN for proximal femur fracture between January 2015 and January 2017 were recruited. Of the 162 patients, 47 (study group) taking antiplatelets preoperatively due to comorbidities were compared with 107 (control group) who were not on antiplatelets. 8 patients taking anticoagulant medication were excluded. Postoperative hemoglobin (Hb) and hematocrit (Hct) levels, transfusion amount and estimated blood loss (EBL), occurrence of venous thromboembolism (VTE) and delirium, intensive care unit (ICU) admission, complications, length of hospital stay, readmission, and in-hospital and 1-year mortalities were measured and compared between the two groups.
A higher number of patients in the study group had concomitant cardiovascular (p = 0.006) and endocrinologic (p = 0.004) diseases, received perioperative transfusion (p = 0.003), and were admitted to ICU postoperatively (p = 0.014). However, there were no significant differences in postoperative Hb and Hct levels, EBL, length of hospital stay, and the incidences of VTE and delirium between the two groups. In addition, in-hospital and 1-year mortalities as well as postoperative complications showed no significant differences between both groups.
CMN can be performed without delay in elderly patients with proximal femoral fracture receiving antiplatelet therapy prior to admission without discontinuing antiplatelets, and is as safe as in patients who are not on antiplatelet medication. However, more caution is required with respect to transfusions and ICU care after surgery in these patients.
由于合并症，老年髋部骨折患者经常使用抗血小板药物。本观察性队列研究旨在评估老年股骨近端骨折患者在进行髓内钉固定术（CMN）期间持续使用抗血小板药物对术后结局的影响。
招募了2015年1月至2017年1月期间连续162例年龄≥70岁因股骨近端骨折接受CMN的患者。在这162例患者中，将47例（研究组）因合并症术前服用抗血小板药物的患者与107例（对照组）未服用抗血小板药物的患者进行比较。排除8例服用抗凝药物的患者。测量并比较两组患者术后血红蛋白（Hb）和血细胞比容（Hct）水平、输血量和估计失血量（EBL）、静脉血栓栓塞症（VTE）和谵妄的发生率、重症监护病房（ICU）入住情况、并发症、住院时间、再次入院情况以及住院期间和1年死亡率。
研究组中合并心血管疾病（p = 0.006）和内分泌疾病（p = 0.004）的患者更多，接受围手术期输血（p = 0.003），术后入住ICU（p = 0.014）。然而，两组患者术后Hb和Hct水平、EBL、住院时间以及VTE和谵妄的发生率无显著差异。此外，两组患者的住院期间和1年死亡率以及术后并发症无显著差异。
对于入院前接受抗血小板治疗的老年股骨近端骨折患者，无需停用抗血小板药物即可立即进行CMN，其安全性与未服用抗血小板药物的患者相同。然而，这些患者术后在输血和ICU护理方面需要更加谨慎。
