纪泉;孙凤坡;张统一;刘军川;王强;

• 1:北京医院骨科国家老年医学中心中国医学科学院老年医学研究院

摘要(Abstract)：

目的：探讨围手术期口服阿司匹林对早期髓内钉固定治疗老年转子间骨折的影响。方法：回顾性分析2013年1月至2019年11月因转子间骨折行闭合复位股骨近端髓内钉固定的入院前口服阿司匹林抗血小板治疗的84例患者的病例资料。患者年龄70～87岁，平均（76.6±4.2）岁。38例患者（持续组）骨折后继续口服阿司匹林并加用低分子肝素；另外46例患者（暂停组）骨折后停用阿司匹林，使用低分子肝素抗凝。比较两组患者的手术时间、失血量、输血量、心脑血管意外事件、消化道溃疡出血、住院时间。结果：持续组患者的心脑血管意外发生率显著低于暂停组（P=0.030），两组患者在手术时间、失血量、输血量、消化道溃疡出血、住院时间方面的差异无统计学意义（P>0.05）。结论：心脑血管意外高风险的老年转子间骨折患者围手术期不停用口服阿司匹林不增加手术的出血量和消化道溃疡出血发生率，不影响早期髓内钉固定手术，且心脑血管意外发生率较低，建议心脑血管意外事件风险高的老年髋部骨折患者围手术期继续口服阿司匹林进行抗血小板治疗。

关键词(KeyWords)： 转子间骨折;阿司匹林;抗血小板治疗;早期手术

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 纪泉;孙凤坡;张统一;刘军川;王强;

参考文献(References)：

• [1]Guzon-Illescas O,Perez Fernandez E,CrespíVillarias N,et al.Mortality after osteoporotic hip fracture:incidence,trends,and associated factors[J].J Orthop Surg Res,2019,14(1):203.
• [2]Papachristos IV,Giannoudis PV.Proximal femur fractures in patients taking anticoagulants[J].EFORT Open Rev,2020,5(10):699-706.
• [3]Devereaux PJ,Mrkobrada M,Sessler DI,et al.Aspirin in patients undergoing noncardiac surgery[J].N Engl J Med,2014,370(16):1494-503.
• [4]Levine GN,Bates ER,Bittl JA,et al.2016 ACC/AHAguideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease:A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J].J Thorac Cardiovasc Surg,2016,152(5):1243-1275.
• [5]Douketis JD,Spyropoulos AC,Spencer FA,et al.Perioperative management of antithrombotic therapy:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e326S-e350S.
• [6]王春玲,王佳.围手术期的抗栓治疗-ACCP9溶栓和抗栓指南启示[J].中国心血管病研究,2012,10(12):929-931.
• [7]Remily EA,Mohamed NS,Wilkie WA,et al.Hip fracture trends in America between 2009 and 2016[J].Geriatr Orthop Surg Rehabil,2020,11:2151459320929581.
• [8]Saul D,Riekenberg J,Ammon JC,et al.Hip fractures:therapy,timing,and complication spectrum[J].Orthop Surg,2019,11(6):994-1002.
• [9]Moja l,Piatti A,Pecoraro V,et al.Timing matters in hip fracture surgery:patients operated within 48 hours have better outcomes.A meta-analysis and meta-regression of over190,000 patients[J].PLo S One,2012,7:e46175.
• [10]Patrono C,Coller B,Fitz Gerald GA,et al.Platelet-active drugs:the relationships among dose,effectiveness,and side effects:the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy[J].Chest,2004,126(3 Suppl):234S-264S.
• [11]Antithrombotic Trialists'(ATT) Collaboration,Baigent C,Blackwell L,et al.Aspirin in the primary and secondary prevention of vascular disease:collaborative meta-analysis of individual participant data from randomised trials[J].Lancet,2009,373(9678):1849-1860.
• [12]Oscarsson A,Gupta A,Fredrikson M,et al.To continue or discontinue aspirin in the perioperative period:a randomized,controlled clinical trial[J].Br J Anaesth,2010,104(3):305-312.
• [13]Lee J,Kim JK,Kim JH,et al.Recovery time of platelet function after aspirin withdrawal[J].Curr Ther Res Clin Exp,2014,76:26-31.
• [14]NICE.Hip fracture:management[J/OL].(2017-05-10)[2021-07-09]https://www.nice.org.uk/guidance/cg124
• [15]Roberts KC,Brox WT.AAOS clinical practice guideline:management of hip fractures in the elderly[J].J Am Acad Orthop Surg,2015,23(2):138-140.
• [16]Plümer L,Seiffert M,Punke MA,et al.Aspirin before elective surgery-stop or continue?[J].Dtsch Arztebl Int,2017,114(27-28):473-480.
• [17]Al Khudairy A,Al-Hadeedi O,Sayana MK,et al.Withholding clopidogrel for 3 to 6 versus 7 days or more before surgery in hip fracture patients[J].J Orthop Surg (Hong Kong),2013,21(2):146-150.
• [18]Chechik O,Thein R,Fichman G,et al.The effect of clopidogrel and aspirin on blood loss in hip fracture surgery[J].Injury,2011,42(11):1277-1282.
• [19]Park JH,Ahn Y,Choi BS,et al.Antithrombotic effects of aspirin on 1-or 2-level lumbar spinal fusion surgery:a comparison between 2 groups discontinuing aspirin use before and after 7 days prior to surgery[J].Spine (Phila Pa 1976),2013,38(18):1561-1565.
• [20]Purushothaman B,Webb M,Weusten A,et al.Decision making on timing of surgery for hip fracture patients on clopidogrel[J].Ann R Coll Surg Engl,2016,98(2):91-95.
• [21]LordkipanidzéM,Diodati JG,Pharand C.Possibility of a rebound phenomenon following antiplatelet therapy withdrawal:a look at the clinical and pharmacological evidence[J].Pharmacol Ther,2009,123(2):178-186.