大腿骨近位部骨折における深部静脈血栓症の術前発生—下肢静脈超音波検査を用いて

Preoperative Incidence of Deep Venous Thrombosis Assessed by Lower Leg Ultrasound in Hip Fracture Patients

　背景：大腿骨近位部骨折術前の深部静脈血栓症(DVT)発生例の患者背景を検討した．

　対象と方法：64例で術前の下肢静脈超音波検査を行った．

　結果：DVTは64例中17例(26.6％)で観察され，近位型5例，遠位型12例であった．近位型DVTは，受傷から2日以内に超音波検査を受けた症例では29例中1例(3.4％)，受傷から3日以降に超音波を受けた症例では35人例中4例(11.4％)で発生し，受傷後3日以降での近位型DVTにおいてより高い発生率の傾向を示唆した．

　まとめ：本骨折では，受傷後早期の手術が推奨されているが，本研究では受傷後早期のDVT発生が確認され，下肢静脈超音波検査による術前の積極的な検索が必要と考えた．

　Background：Pulmonary embolism can be a fatal complication after hip fracture surgery.　We performed a lower leg ultrasound examination on hip fracture patients and evaluated patient background and their incidence of preoperative deep venous thrombosis (DVT).

　Methods：Between January 2011 and October 2013, 64 hip fracture patients underwent lower leg ultrasound before surgery.

　Results：DVT was observed in 17 of the 64 (26.6%) patients.　Proximal DVT was detected in five patients and distal DVT in 12 patients.　DVT was detected in nine of the 29 patients who underwent an ultrasound examination within 2 days of the injury, and in eight of the 35 patients who underwent an ultrasound examination 3 or more days after the injury.　Proximal DVT was detected in one of the 29 (3.4%) patients who underwent the ultrasound examination within 2 days of the injury, and in four of the 35 (11.4%) patients who underwent the ultrasound examination after 3 days or more.

　Conclusions：Early operation after a hip fracture is recommended, however, in this study we observed DVT formation even when the ultrasound examination was performed soon after the injury.　We concluded that a vigorous search for DVT by lower leg ultrasound examination should be performed even in the postoperative period.