脊柱外科手术后静脉血栓栓塞症自然发生率的临床研究-clinical study on the natural occurrence rate of venous thromboembolism after spinal surgery.docx

年龄为11岁，男性患者87名（51.8%），女性患者81名(48.2%)，接受颈椎手术的患者33例(19.6%)，接受胸椎手术的患者6例(3.6%)，接受胸腰椎手术的患者12例(7.2%)，接受腰椎手术的患者117例(69.6%)，手术后患者下床活动时间为1到10天，平均为2.7天。在全部患者中，发现下肢静脉血栓形成1例，未发现肺血栓形成的病例。有1名“腰椎管狭窄症”患者在术后15天，左下肢突发肿胀、乏力、疼痛不适，行双下肢静脉彩超检查提示左侧股总静脉、胫后静脉血栓，再经CT静脉造影确诊。患者最后经治疗后康复出院。本次研究发现脊柱外科手术后VTE发生率为0.60%。应该运用统计学方法分析脊柱术后VTE阳性组与阴性组在性别、手术部位、年龄、体重、手术时间、手术入路、手术时失血量、卧床时间等方面是否存在显著差异。但由于VTE阳性例数少，随机性大，故未能运用统计学的方法进行分析。结论：本次研究的结果与文献报告相类似，均显示脊柱外科手术在围手术期不采用任何抗凝措施的情况下，出现双下肢静脉血栓形成的自然发生率较低；脊柱外科手术后对于无VTE症状的患者不需要常规行双下肢静脉彩超检查、血管造影检查以及常规抗凝处理等。对没有存在VTE危险因素的患者不建议常规进行抗凝处理。当然，手术过程中应尽量减少植入物的使用，避免压迫腹部大静脉等；脊柱外科手术后应早期鼓励患者进行双下肢活动并尽量缩短卧床时间、下地活动。关键词脊柱外科手术下肢深静脉血栓肺栓塞发生率ABSTRACTBACKGROUND:VenousThromboemlolismincludesDeepVeinVhrombosis(DVT)andPulmonaryEmbolism(PE).DVTandPEarewell-knowedcomplicationsafterorthopedicprocedures.IthasalsobeenwelldocumentedthattheincidenceofDVTorPErangesfrom0.3%to31%.However,spinesurgeryhasbeenassociatedwithfewerthromboticcompliacationscomparedwithotherreconstructivesurgeriesofthehipandknee(20%-70%).Totheauthors’knowledge,therehasbeenfewpreviousstudiesthathavedemonstratedtheincidenceofDVTorPEafterreconstructivespinalsurgery,especiallywithoutanyprophylaxis.OBJECTIVE:Throughtheprospectiveclinicalstudy,todemonstratetheprevalenceofDVTorPEafterreconstructivespinalsurgeryinmyapartmentandifthereisnecessaryforroutinescreeningtestsafterreconstructivespinalsurgery.Alsoprovidesgeneralbenchmarksofclinicallyevidentasabasisforongoingeffortstoimprovesaftetyofcare.WecomparetheincidenceofDVTorPEafterreconstructivespinalsurgeryinthisstudywiththatinthepublishedstudiestodetermineifthereisnecessaryofusingantithromboticprophylaxistolowertheprevanceofVTE.METHODS:Materials:Thisprospectivestudyincluded168patientsintheDepatmentofOrthopedicSurgery,GuangdongProvincePeople’sHospitalfromJan,2011toJan,2012.Standardforinclude:(1)Thepatientswhounderwentmajorreconstructivespinesurgery(majorreconstructivespinaproceduresforthisstudyweredefinedasthoseinvolvinganteriorand/orposteriorspinalfusionsand/ordecompressions).(2)GeneralA