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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2018, Vol. 04 ›› Issue (02) : 70 -74. doi: 10.3877/cma.j.issn.2096-0263.2018.02.002

所属专题： 文献；

深静脉血栓

床旁超声在股骨颈骨折患者围手术期下肢深静脉血栓筛查中的作用
姚尧1, 乔梁1, 王业贤1, 邱君斓2, 蒋智明2, 沈祎2, 朱澄妍2, 陈东阳1, 徐志宏1, 史冬泉1, 戴进1, 张炜炜2, 蒋青1,†()   
  1. 1. 210008　南京大学医学院附属鼓楼医院运动医学与成人重建外科
    2. 210008　南京大学医学院附属鼓楼医院外科超声室
  • 收稿日期:2017-10-05 出版日期:2018-04-05
  • 通信作者: 蒋青
  • 基金资助:
    国家自然科学基金(81672239)

The clinical value of bedside ultrasound in the screening of perioperative lower extremity deep vein thrombosis in elderly patients with femoral neck fracture

Yao Yao1, Liang Qiao1, Yexian Wang1, Junlan Qiu2, Zhiming Jiang2, Yi Shen2, Chengyan Zhu2, Dongyang Chen1, Zhihong Xu1, Dongquan Shi1, Jin Dai1, Weiwei Zhang2, Qing Jiang1,†()   

  1. 1. Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210008, China
    2. Surgical Ultrasonography Room, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210008, China
  • Received:2017-10-05 Published:2018-04-05
  • Corresponding author: Qing Jiang
  • About author:
    Corresponding author: Qing Jiang, Email:
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引用本文：

姚尧, 乔梁, 王业贤, 邱君斓, 蒋智明, 沈祎, 朱澄妍, 陈东阳, 徐志宏, 史冬泉, 戴进, 张炜炜, 蒋青. 床旁超声在股骨颈骨折患者围手术期下肢深静脉血栓筛查中的作用[J/OL]. 中华老年骨科与康复电子杂志, 2018, 04(02): 70-74.

Yao Yao, Liang Qiao, Yexian Wang, Junlan Qiu, Zhiming Jiang, Yi Shen, Chengyan Zhu, Dongyang Chen, Zhihong Xu, Dongquan Shi, Jin Dai, Weiwei Zhang, Qing Jiang. The clinical value of bedside ultrasound in the screening of perioperative lower extremity deep vein thrombosis in elderly patients with femoral neck fracture[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2018, 04(02): 70-74.

目的

探讨床旁超声在老年股骨颈骨折患者血栓筛查的应用价值。

方法

回顾性收集2016年1月至2017年3月南京大学医学院附属鼓楼医院运动医学与成人重建外科收治的股骨颈骨折患者，术前常规用床旁超声行双下肢深静脉检查，观察血管内径、血栓部位、血栓回声以及血流情况。所有术前血栓患者于术后行常规随访观察。

结果

共纳入135例患者，男性45例，女性90例；平均年龄（76±8）岁，平均身体质量指数为（22±3）kg/m2。术前共发现血栓45例，其中近端血栓7例，远端血栓38例。根据血栓累及部位，其中累及髂静脉1例，股静脉4例，腘静脉4例，腓静脉5例，胫后静脉3例，肌间静脉血栓40例。13例血栓患者暂停手术并接受治疗，治疗期间彩超隔日观察血栓溶解情况，其中经治疗好转10例，血栓无变化2例，加重1例，2例在术前置入下腔静脉滤器。术后彩超观察中，3例术前血栓患者在术后观察中发现进展至其他静脉，均及时接受抗凝治疗并通过床旁彩超随访，未见有血栓脱落以及肺栓塞形成。

结论

床旁超声可用于股骨颈骨折患者血栓的诊断、监测及随访。

关键词: 血栓形成, 多普勒超声, 股骨颈骨折, 关节成形术，置换，髋
Objective

To investigate the clinical value of bedside ultrasound in detection of deep vein thrombosis in elderly patients with femoral neck fracture.

Methods

A retrospective study was performed in patients with femoral neck fractures who underwent bilateral ultrasound in department of Sports Medicine and Adult Reconstructive Surgery of Drum Tower Hospital Affiliated to Medical School of Nanjing University from January 2016 to March 2017. The diameter of blood vessel, location, echo and blood flow were evaluated. Postoperative ultrasound were conducted routinely during hospitalization and after discharge.

Results

A total of 135 patients were enrolled in this study. There were 45 males and 90 females. The average age was 76±8 years old and the average body mass index was 22±3 kg/m2. Forty-five cases were diagnosed DVT. Seven cases were proximal DVT and thirty eight were distal. According to the anatomical location, one located in the iliac vein, four located in the femoral veins, four located in the popliteal veins, five cases located in the peroneal veins and three cases located in the posterior tibia veins, forty one cases located in the muscular vein. Surgeries were postponed in 13 DVT patients and all of them received thrombosis treatment and ultrasound screening every other day. Results showed that 10 cases were significantly improved, two cases had no improvement and one case aggravated, two cases received inferior vena cava filters. During postoperative screening, three preoperative DVTs were found to progress into other veins and all of them received treatment and the follow-up screening showed that no DVT failed off and no pulmonary embolism happened.

Conclusion

Bedside ultrasound can be used in the diagnosis, monitoring and follow up of DVT in patients with femoral neck fracture.

Key words: Thrombosis, Ultrasonography, Femoral neck fractures, Arthroplasty, replacement, hip
表1 两组股骨颈骨折患者一般资料比较
组别 例数 性别（例） 体质量指数（kg/m2，±s） 年龄（岁，±s） 高血压（例） 糖尿病（例） 脑梗病史（例） 肿瘤病史（例）
男 女 有 无 有 无 有 无 有 无
非血栓组 90 30 60 22±4 75±9 45 45 18 72 0 60 7 83
血栓组 45 15 30 22±4 78±7 32 13 10 35 20 25 0 45
统计值 ? χ2=0.000 t=0.549 t=-1.853 χ2=5.546 χ2=0.090 χ2=1.588 χ2=2.279
P值 ? 1.000 0.584 0.066 0.019 0.764 0.208 0.131
表2 45例股骨颈骨折患者血栓发生部位以及频率
血栓累及部位 总例数（n=45）
近端血栓 7
? 腘静脉+肌间静脉 3
? 股静脉 2
? 髂静脉+股静脉+肌间静脉 1
? 股静脉+腘静脉+腓静脉+胫后静脉+肌间静脉 1
远端血栓 38
? 肌间静脉 32
? 腓静脉 2
? 腓静脉+肌间静脉 2
? 胫后静脉+肌间静脉 1
? 胫后静脉 1
表3 45例股骨颈骨折患者术前血栓超声图像特点
部位 例数 ? 回声表现 血管是否扩张 是否能压闭 血栓边缘与管壁关系 彩色多普勒血流信号
低回声 混合或者高回声 是 否 完全不能 部分能 清晰 不清 无 部分
远端静脉 43* 34 9 30 13 25 18 20 23 30 13
近端静脉 7 6 1 4 3 2 5 5 2 2 5
图5~10 女性，72岁，右髋部外伤后5 d后入院。图5　入院后查彩超示右侧肌间静脉血栓形成，彩色多普勒超声示仅见少量血流信号；图6　二维超声示肌间静脉内有不均匀絮状回声（红色箭头处）；图7　术后3 d复查彩超发现腘静脉血栓形成，二维超声示右侧腘静脉内见絮状回声（红色箭头处）；图8　横切腘静脉血管提示仅部分血管有血流信号；图9　术后3个月复查右侧股静脉和腘静脉完全通畅，彩色多普勒超声示右侧腘静脉彩色血流信号正常，提示血流完全通畅；图10　右侧股静脉处血流信号正常，提示血流完全通畅
1
Geerts WH, Pines GF, Heit JA, et a1. Prevention of venousthromboembolism: the Seventh ACCP Conference on Antithrombotic andThrombolytic Therapy [J]. Chest, 2004, 126(3 Suppl)：338-400.
2
Girasole GJ, Cuomo F, Denton JR, et al. Diagnosis ofdeep vein thrombosis in elderly hip-fracture patients by using the duplexscanning technique [J]. Orthop Rev, 1994, 23(5): 411-416.
3
Hefley FG, Nelson CL, Puskarich-May CL. Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip [J]. J Bone Joint Surg Am, 1996, 78(4): 581-583.
4
Roberts TS, Nelson CL, Barnes CL, et al. The preoperative prevalence and postoperative incidence of thromboembolism in patients with hip fractures treated with dextran prophylaxis [J]. Clin Orthop Relat Res, 1990, 255:198-203.
5
Stevens J, Fardin R, Freeark RJ. Lower extremity thrombophlebitis in patients with femoral neck fractures. A venographic investigation and a review of the early and late significance of the findings [J]. J Trauma, 1968, 8(4): 527-534.
6
Song K, Yao Y, Rong Z, et al. The preoperative incidence of deep vein thrombosis (DVT) and its correlation with postoperative DVT in patients undergoing elective surgery for femoral neck fractures [J]. Arch Orthop Trauma Surg, 2016, 136(10): 1459-1464.
7
Zahn HR, Skinner JA, Porteous MJ. The preoperative prevalence of deepvein thrombosis in patients with femoral neck fractures and delayedoperation [J]. Injury, 1999, 30(9): 605–607.
8
姚尧, 邱君斓, 乔梁, 等. 人工关节置换术围手术期肌间静脉血栓的形成与转归[J]. 中华骨科杂志, 2016, 36(19): 1236-1242.
9
Smith EB, Parvizi J, Purtill JJ. Delayed surgery for patients with femur and hip Fractures-Risk of deep venous thrombosis [J]. J Trauma, 2011, 70(6): E113-E116.
10
王琦, 孙辉, 张先龙, 等. 老年股骨颈骨折患者关节置换术前深静脉血栓形成的发生率[J]. 中华创伤骨科杂志, 2010, 12(12): 1119-1123.
11
Antignani PL, Aluigi L. The calf vein thrombosis [J]. Reviews in Vascular Medicine, 2013, 1(1): 1-4.
12
Mattos MA, Melendres G, Sumner DS, et al. Prevalence and distribution of calf vein thrombosis in patients with symptomatic deep venous thrombosis: a color-flow duplex study [J]. J Vasc Surg, 1996, 24(5): 738-744.
13
Kageyama N, Ro A, Tanifuji T, et al. Significance of the soleal vein and its drainage veins in cases of massive pulmonary thromboembolism [J]. Ann Vasc Dis, 2008, 1(1): 35-39.
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