Clinical Study On Preoperatively Intervented For Patient With Hypercoagulable State Of Hip Fracture By Acupuncture

ObjectiveTo observe the efficacy and safety of acupuncture preoperatively intervented on hypercoagulable state at hip fracture, providing scientific basis for clinical application of acupuncture in preventing DVT.MethodsFrom March,2013to January,2014,67cases of traumatic hip fracture patients(including femoral neck fracture, intertrochanteric fracture) that meet the study criterias were selected, from the Deparment Ten of Orthopedics in Foshan hospital of TCM. The67patients were randomly divided into two groups. The control group (33cases)were received the routine treatments of traumatic orthopedics, such as applying external medichine (Huangshuisha), elevating the effected lower-limb, guiding function exercise (isometric muscle contraction, ankle function exercise), treated to one day before the surgery. The acupuncture group (34cases) received the same treatments (like the control group) and acupuncture treatment (one time a day,30minutes one time), Xuehai, Liangqiu, Zusanli, Sanyinjiao, Taichong pionts were selected in the bilateral lower limbs. All patients were received the following blood examination within24hours after injury and one day before operation, such as PLT、PT、APTT、TT、D-Dimer、FBG、FDP and TEG. The affected lower extremity vascular color Doppler examination were also needed in these two days.Results(1)PLC:On the day before operation, the average of the PLC was lower compared to the24hours after injury in the acupuncture group, while the control group was higher. Before and after treatment, both groups showed significant difference (P<0.05).One day before operation between the acupuncture group and the control group was statistically significant (P<0.05).(2)PT、TT and APTT:Three indexes were in the normal range in two groups of patients within24hours after injury. Within24hours after injury and one day before surgery two groups had no significantly difference(P>0.05). In these two days, the acupuncture group itself showed no statistical significance (P>0.05). The control group showed no statistical significance in APTT and TT (P>0.05), except PT in these two days (P<0.05).(3) D-Dimer、FBG and FDP:The three indexes were significantly higher than the normal level in the two groups of patients within24hours after the injury.The average level of three indexes decreased significantly in acupuncture group on the day before operation, itself coparing had a significant difference (P<0.01). While the control group on the day before surgery was still higher than the normal level, itself coparing had no significant difference (P>0.05). On the day before operation, two groups have a significant differences (P<0.01).(4)TEG observation:Both MA and G were higher than the normal level within24hours after injury in the two groups of patients. The acupuncture group itself comparing, all parameters (R、K、a angle、MA and G) had a significant differences(P<0.05),the mean of each parameter declined compared to the24hours after injury, while the parameters had no significant differences in the control group (P>0.05). Within the24hours after injury, two groups had no significant differences in each parameter. On the day before operation, two group of patients had a significant difference in R、a angle、MA and G (P<0.05), except K(P>0.05).(5) The incidence of DVT:One day before operation,34patients in the acupuncture group there were1cases of intramuscular venous thrombosis, the incidence of DVT was2.94%; the control group of33patients had3cases of thrombosis, including1cases of superficial femoral vein thrombosis,1cases of popliteal vein thrombosis,1cases of intramuscular venous thrombosis, the incidence of DVT was9.09%, the incidence of DVT between the two groups showed no statistical significance (P>0.05).Conclusion(1) Acupuncture can obviously reduce the D-Dimer, FBG、FDP、MA and G, prolong R and K, narrow the a angle, indicated that acupuncture can improve the hypercoagulable state after traumatic hip fracture.(2) Acupuncture has no significant impact on thrombin time (TT), prothrombin time (PT) and activated partial prothrombin time (APTT), indicated that acupuncture could not increase blood loose during and after the surgery, so it is safe and effective, early application after fracture is availabled.