| Objective:To investigate the occurrence rule and prognosis of theperioperative deep venous thrombosis in patients with femoral neckfracture and accepted total hip arthroplasty,and to analysis therelated influence factors.Method:To investigate the relative patients clinical data asretrospective study in orthopaedics department of the First Hospitalof JiLin University from October2013to October2014。Followedthe historical information and treatment records， collecting therelative information including basic information, the classification ofthe femoral neck fracture,the comorbidities,the leve of D-dimer,thetype of surgical procedures, perioperative prevention andtreatment of LDVT,preoperative results of lower limb deep vennousultrasound;and collect the data of3months postoperativefollow-up,including Harris hip joint function scale,the occurrence ofLDVT,thromboembolic event and death situation.Analysis the datausing the method of multi-factor group study by the software of SPSS19.0.Results:Between October2013and2014our unit carried out55primary hip replacements for the reason of femoral neck fracturewith34females and21males,aged from59-99, at a mean age of68.7±11.1,according to Garden Classification of femoral neckfracture,there are10Garden stage II,33Garden stage III,12Garden stage IV.Among this55patient,12(21.8%)have sufferedLDVT after the fracture,43(78.2%)did not preoperatively.Theaverage of the D–dimer in the group of patient with preoperativeLDVT was0.824±0.481ug/ml,three LDVT was diagnosed within3months postoperatively,and the average of postoperative Harriship score was85.50±5.054,the mortality was0.In the group ofpatients without LDVT before surgery,the average of the D-dimerwas1.261±1.275ug/ml,there was1patient was diagnosed withLDVT after THR within3months, the average of postoperativeHarris hip score was86.51±4.426, the mortality was0.Statistical analysis result:The rate of preopertive LDVT in less than1day,1~7days,7~14days and more than14days after the fracture till theexamination of deep venous ultrasound are0%，24.1%，50.0%，23.1%respectively,although the rate show a increasing trend generally, the days to the time of getting deep venous ultrasoundafter fracture showed non-significant effect on the occurrence ofLDVT（P>0.05）on the whole;The gender showed no significanteffect on the occurrence of post-fracture LDVT(P>0.05),rate ofmale group was19.0%,rate of female group was23.5%;The rate ofthe occurrence of the post-fracture LDVT in50～60，60～70，70～80，80～90，90～100years old group were13.6%，5.3%，33.3%，33.3%，0%,though different age should no statistical differences,theoverall trend of rate increased with age. The data of D-dimer inpost-fracture LDVT group and without LDVT group showed nostatistical differences(P>0.05);The type of Garden Classificationshowed significant differences in three group(P<0.05);The rate ofpost-fracture LDVT in patients with preoperative complications washigher(33.3%) than the patients who did not have(14.7),but showedno no statistical differences of the two group(P>0.05).The rate ofpostoperative LDVT in preoperative LDVT group was25%,and2.3%in the group without preoperative group,the P-value was0.038<0.05,preoperative LDVT showed significant effect on theoccurrence of post surgery LDVT;The ways of perioperativeanticoagulation showed non-significant effect on the rate of postoperative LDVT(P>0.05);The postoperative Harris hip scores inpreoperative LDVT group and the group without preoperative LDVT showed no statistical differences(P>0.05).Conclusion:1.Patients with advanced age,long time before surgery afterfracture and comorbidities are more more likely to get LDVT afterfemoral neck fracture.2.Although having been well treated,patients withpreoperative LDVT,even take proper anticoagulation measures,stillhave higher risk for LDVT than patients without within3monthspostoperative.For these patients,regular lower limb deep venousultrasound examination will be well for recovery. |
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