Efficacy comparison between operation and non-operation treatment for hip fractures patients complicated with pulmonary embolism / 中华创伤杂志

ABSTRACT

Objective To investigate efficacy of operation and non-operation treatment for hip fractures patients complicated with pulmonary embolism.Methods A retrospective case control study was conducted to analyze the clinical data of 18 hip fracture patients complicated with pulmonary embolism admitted to Dongyang People's Hospital from May 2017 to January 2019.There were 11 males and seven females,aged 59 to 96 years[(80.0 ± 9.3)years].There were 10 patients with intertrochanteric fractures,one with femoral subtrochanteric fracture and seven with femoral neck fractures.After diagnosis of pulmonary embolism,the patients were given anticoagulant therapy with low molecular weight heparin for at least one week.The re-examination showed that pulmonary embolism absorption improved and D-dimer did not increase.Eleven patients chose surgical treatment (operation group) with intramedullary nail internal fixation or artificial hip replacement.Seven patients chose non-surgical treatment (non-operation group) with skin traction.The Harris score of hip function was compared between the two groups.Visual analogue scale (VAS) was used to evaluate hip joint pain.At the last follow-up,fracture healing,prognosis of pulmonary embolism and mortality within 3 months were recorded.Results All the patients were followed up for 3-22 months [(11.2 ± 6.0) months].At last follow-up,the Harris score was (92.1 ± 2.2) points in the operation group and (28.8 ± 18.8) points in the non-operation group (P＜0.01);the VAS was 0 point (0-1 point) in the operation group and 3 points (1-3 points) in the non-operation group (P ＜ 0.01).At the last follow-up in the operation group,five patients obtained fracture healing after internal fixation,and among the six patients receiving artificial joint replacement,five patients recovered well except for one deceased patient.At the last follow-up,pulmonary embolism was absorbed and no recurrence of pulmonary embolism was found.None of the patients died within 3 months in operation group,while 14％ of the patients (1/7) in the non-operation group died within 3 months.Conclusions For hip fracture patients complicated with pulmonary embolism,compared with non-operation treatment,operation treatment is more beneficial to restore hip function and relieve pain,with lower mortality rate within 3 months.Operation treatment is feasible for patients who showed improved absorption of pulmonary embolism and no secondary increase of D-dimer after one to two weeks of full anticoagulation treatment before operation.