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有小腿外伤和因小腿石膏绷带或支架固定无法移动的患者发生深静脉血栓形成的风险增加。对 6 项随机对照试验 (RCT) 进行了 Cochrane 综述，发现接受每日预防措施的小腿固定患者中，VTE 发生率显著低于无预防的患者或接受安慰剂的患者。[96]Testroote M, Stigter WA, Janssen L, et al. Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization. Cochrane Database Syst Rev. 2014 Apr 25;(4):CD006681.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006681.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/24771319?tool=bestpractice.com 然而由于这些研究结果包括经过筛查性静脉造影或超声明确诊断的无症状深静脉血栓栓塞，因不推荐下肢固定的患者进行常规性血栓预防治疗。[97]Falck-Ytter Y, Francis CW, Johanson NA, et al; American College of Chest Physicians. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e278S-e325S.http://journal.chestnet.org/article/S0012-3692(12)60126-3/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/22315265?tool=bestpractice.com 对接受髋关节或膝关节置换手术的患者的 16 项随机试验进行了另一项 Cochrane 综述，结果提示，术后使用抗凝剂预防静脉血栓栓塞有“中等质量证据”；然而，有小出血的风险。[98]Forster R, Stewart M. Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair. Cochrane Database Syst Rev. 2016 Mar 30;3:CD004179.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004179.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/27027384?tool=bestpractice.com [  ]How do anticoagulants compare following total hip or knee replacement or hip fracture repair?https://cochranelibrary.com/cca/doi/10.1002/cca.1415/full显示答案 这项综述中的试验同时包含膝关节和髋关节置换术以及择期患者和髋部骨折患者的髋关节置换术。 并且，没有试验评估接受髋部骨折固定的患者。 有人建议预防适用于所有髋部骨折患者；然而，关于使用哪种药物、使用多长时间以及后续的并发症权衡，证据很少。[99]Marsland D, Mears SC, Kates SL. Venous thromboembolic prophylaxis for hip fractures. Osteoporos Int. 2010 Dec;21(Suppl 4):S593-604.http://www.ncbi.nlm.nih.gov/pubmed/21057999?tool=bestpractice.com
Deep vein thrombosis
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