目的 探讨利伐沙班在预防陈旧性下肢复杂骨折合并弥漫性轴索损伤患者术后深静脉血栓形成方面的安全性及临床疗效.方法 回顾分析我院2005年7月-2012年3月收治的240例复杂“股骨或胫骨平台”陈旧性骨折(外伤时间＞3周)合并弥漫性轴索损伤的临床资料,其中2010年6月-2012年3月收治的120例作为观察组,骨折术后48 h始接受常规口服利伐沙班,每日1片,应用4周,期间参考D-二聚体变化,定期复查颅脑CT.选取2005年7月-2010年6月收治的120例作为对照组,骨折术后未常规抗凝治疗.统计两组深静脉血栓发生率,并观察颅脑出血的情况.结果 所有患者随访3个月,观察组及对照组均无颅脑出血发生,观察组深静脉血栓发生率为5.0％ (6/120),对照组为30.0％ (36/120),两组比较差异有统计学意义(P＜0.05).结论 对于陈旧性下肢复杂骨折合并弥漫性轴索损伤患者,术后应用利伐沙班能够有效预防血栓形成,安全、可靠且疗效满意.%Objective To evaluate the clinical efficacy of rivaroxaban prevention in deep vein thrombosis (DVT) in patients with stale fracture of lower limb combined with postoperative diffuse axonal injury. Methods Clinical data of 240 patients with stale femoral/tibial plateau fracture combined with diffuse axonal injury admitted to our hospital during May 2005 and March 2012 were retrospectively analyzed. 120 patients during June 2010 and March 2012 were recruited as therapy group. Oral Rivaroxaban (10 mg once per day) was administered 48 hours after operation for 4 weeks. Brain CT scans were regularly checked according to D-dimer. Another 120 patients with the same disease admitted during May 2005 and May 2010 as control group underwent operations without regular anticoagulant treatment. Incidence rates of deep vein thrombosis in two groups were detected, and conditions of cerebral hemorrhage were observed. Results All the patients were followed up for 3 months. No cerebral hemorrhage occurred in either group. The DVT rate was 5.0% (6/120) in therapy group and 30.0% (36/120) in control group. The difference of two groups was statistically significant (P<0.05). Conclusion Rivaroxaban can effectively and safely prevent postoperative DVT in patients with stale fracture of lower limb combined with diftuse axonal injury.
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