Effects of close reduction intramedullary nailing fixation on perioperative venous thrombosis-related indicators

doi:10.3969/j.issn.2095-4344.0255

Abstract

Abstract:

BACKGROUND: In recent years, closed femoral intramedullary nail has been widely used in the treatment of femoral fractures. Especially, in elderly patients, the advantage of closed femoral intramedullary nail is obvious.

OBJECTIVE: To evaluate the effects of close reduction and open reduction intramedullary nailing fixation on blood coagulation and D-dimer in the treatment of aged femur fractures so as to assess the risk of deep venous thromboembolism after closed femoral intramedullary nail fixation.

METHODS: Totally 95 old femur fracture patients were selected at the Linyi Central Hospital from October 2013 to July 2016. They were treated with close reduction and open reduction intramedullary nailing fixation.

RESULTS AND CONCLUSION: Compared with open reduction, intraoperative blood loss was lower (P < 0.05); mean operation time was shorter (P < 0.05); prothrombin time was longer (P < 0.05); plasma fibrinogen was lower (P < 0.05); plasma D-dimer content was less (P < 0.05) in the close reduction group. These findings indicate that close reduction intramedullary nailing fixation is an effective therapeutic method in the treatment of aged femur fractures, can reduce hemagglutination index after fixation, and reduce the risk of deep venous thromboembolism.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Venous Thrombosis, Femoral Fractures, Tissue Engineering

CLC Number:

R318

Li Ming, Wan Fa-qing, Zhang Ying-hua, Jia Tang-hong, Luo Gong-zeng, Ju Liang, Huang Shou-guo. Effects of close reduction intramedullary nailing fixation on perioperative venous thrombosis-related indicators [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(23): 3609-3614.

Figures/Tables 3

2.2 手术指标切开复位组术中出血量为(165±52)mL，闭合复位组术中出血量为(86±12)mL，两组差异有显著性意义(P < 0.05)。闭合复位组平均手术时间(53±23)min，切开复位组平均手术时间(82±39)min，两组差异有显著性意义(P < 0.05)。 2.3 凝血酶原时间如表2所示，两组内固定前凝血酶原时间接近，而内固定后24 h和7 d时与内固定前相比均有升高(P < 0.05)。内固定后24 h及内固定后7 d，两组凝血酶原时间差异有显著性意义(P < 0.05)。 2.4 血浆纤维蛋白原水平表3显示，2组内固定前血浆纤维蛋白原水平差异无显著性意义，而内固定后24 h和7 d时与内固定前相比均有明显提升(P < 0.05)。内固定后24 h及7 d时2组血浆纤维蛋白原水平差异有显著性意义(P < 0.05)。 2.5 血浆D-二聚体水平表4显示2组内固定前血浆D-二聚体质量浓度差异无显著性意义(P > 0.05)，而内固定后 24 h和7 d时血浆D-二聚体水平均比内固定前有所升高 (P < 0.05)，且内固定后24 h及7 d时2组血浆D-二聚体水平差异有显著性意义(P < 0.05)。 2.6 影像学结果内固定后X射线检查中闭合复位组部分病例只是实现了功能复位，未解剖复位，但是不影响内固定后愈合及内固定后患者功能康复。切开复位组骨折线复位好，部分可实现解剖复位，内固定后能否愈合根据创伤情况及术中软组织及骨膜血运保护程度而定，有一定的骨折不愈合风险。 2.7 典型病例患者1，男，66岁，重物砸伤致股骨多段粉碎性骨折，经闭合复位髓内钉内固定治疗后，患者股骨得到有效固定(图2A-C)。患者2，男，69岁，高处坠落致股骨转子下粉碎性骨折，经闭合复位髓内钉内固定治疗后，患者股骨得到有效固定(图2D-F)。患者3，男，72岁，车祸伤致股骨转子下粉碎性骨折，经切开复位髓内钉内固定治疗后，患者股骨得到有效固定(图2G-I)。 "

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