不停用抗血小板药物早期微创手术治疗老年髋部骨折的安全性

目的 探讨围手术期不停用抗血小板药物早期微创手术治疗老年髋部骨折的安全性。方法 收集2012年1月至2013年12月采用股骨近端髓内钉治疗的老年股骨粗隆间骨折患者资料，其中32例因心脑血管疾患长期口服抗血小板药物而在不停用抗血小板药物的情况下行早期闭合复位微创髓内钉治疗。回顾分析32例患者的性别、年龄、美国麻醉医师协会（ASA）分级、骨折AO分型、受伤到手术时间、术前和术后血红蛋白、住院时间、ICU时间、出血量、术后输血量、术后切口并发症、全身并发症以及1个月内和1年内死亡率等资料，评估不停用抗血小板药物早期手术治疗老年股骨粗隆间骨折患者的安全性。结果 32例患者中男性11例、女性21例，骨折时年龄65~81岁，单纯使用氯吡格雷者25例、使用氯吡格雷联合阿司匹林者7例，受伤到手术时间2~13（4.8±2.5）d，平均手术时间（89.0±33.2）min。术中出血量（242.9±83.7）mL，术后引流血量（259.8±94.9）mL，术后血红蛋白（73±11）g/L，术后输血量（390.2±103.1）mL。术后ICU停留时间为（1.7±0.9）d，住院时间为（12.5±2.5）d。发生术后切口并发症3例（9.4%），其中2例切口愈合不良、1例切口周围血肿。术后1个月内并发急性心血管事件3例（9.4%），急性脑卒中2例（6.2%），肺炎2例（6.2%），压疮1例（3.1%）。术后1个月内死亡3例（9.4%），术后1年内死亡12例（37.5%）。结论 不停用抗血小板药物早期微创手术治疗长期服用抗血小板药物合并股骨粗隆间骨折的老年患者，不会增加1年内患者的局部和全身并发症发生率。
Objective To explore the safety of early minimally invasive surgery without stopping anti-platelet drugs in treatment of elderly patients with hip fractures. Methods Data of elderly patients with femoral intertrochanteric fractures treated with proximal femoral intramedullary nail between Jan. 2012 and Dec. 2013 were collected, in which 32 patients who took long-term oral anti-platelet drugs due to cardiovascular and cerebrovascular disorders received early closed reduction of minimally invasive intramedullary nail treatment without stopping anti-platelet drugs. Retrospective study was performed to analyze the clinical data of 32 patients, including gender, age, ASA score, fracture AO type, time from injured to surgery, pre- and post-operative hemoglobin, hospital stays, ICU stays, bleeding volume, post-operative blood transfusions, incision complications, systemic complications and intra-1-month and 1-year mortality. Results Thirty-two patients were aged 65-81 years old, with 11 males and 21 females. Twenty-five patients were taking only clopidogrel and 7 patients were taking both clopidogrel and aspirin. The mean time from injured to surgery was (4.8±2.5) d (range 2-13 d), and the mean operative time was (89.0±33.2) min. The mean inter-operation bleeding volume, post-operative drainage volume, post-operation hemoglobin and post-operative blood transfusions were (242.9±83.7) mL, (259.8±94.9) mL, (73±11) g/L, and (390.2±103.1) mL, respectively. The ICU stays was (1.7±0.9) d and the hospital stays was (12.5±2.5) d. Three patients experienced post-operative incision complications (9.4%), with 2 poor incision and 1 incisional hematoma. During the first month after surgery, acute cardiovascular event was found in 3 cases (9.4%), acute stroke in 2 cases (6.2%), pneumonia in 2 cases (6.2%), and pressure ulcer in 1 case (3.1%). Three patients (9.4%) died during