成人脊柱术后下肢深静脉血栓形成的防治对策

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Abstract Objective To evaluate the safety and validity of layered measures in protecting spine surgery patients from deep venous thrombosis.Methods A total of 714 patients were recruited who had managed in the second affiliated hospital of Inner Mongolia medical university for spine surgery from 2015.03 to 2016.03.All cases were assessed the thrombosis risk factors according to Caprini criteria and guarded layered against thrombosis on the basis of VTE.Preventive measures comprised the physical prevention，including grading pressure stretch hose (thigh-length thromboembolic deterrent stockings，TEDS) and intermittent pneumatic compression devices (pneumatic sequential compression will device，PSCD)，and drug prevention with use of low molecular heparin intramuscular injection.Lower extremities vascular doppler ultrasound was performed prior to operation and on the day patients were enough to walk after surgery (people unable to walk was performed after 7～14 day of surgery) in order to evaluate for deep vein thrombosis.Postoperative flow and drainage of liquid color were monitored as well，whether having the incision hematoma，errhysis，whether epidural bleeding induced nerve injury symptoms and low molecular heparin induced thrombocytopenia occur were observed and recorded simultaneously.Results 714 cases of spinal surgery patients (8 cases of combined spinal cord or cauda equina nerve damage.) were inspected using the double lower extremities vascular doppler ultrasound and DVT occurred in 16 cases，incidence of DVT was 2.24％.According to the Caprini score，there was one case suffering from DVT in 119 patients of high-risk group (0.08％)，and 15 DVT cases in 594 patients of very high risk group (2.53％).No patients had pulmonary embolism (PE).The thrombus were all Peripheral ones，rather than hybrid and central thrombus，that included one popliteal venous thrombosis case(0.14％)，3 posterior tibial vein thrombosis case (0.42％)，and 2 venous thrombosis cases (0.28％)，10 muscular venous thrombosis cases (1.40％).DVT occurred on the left leg in 10 cases，right leg in 5 cases and double lower limbs in 1 case，in 9 cases of male and 7 cases of female by gender.12 cases had typical clinical symptoms and signs and 4 cases were symptomless.Results of postoperative 3 months doppler ultrasound showed the recanalization in all DVT cases.The incision errhysis occurred in 4 cases，incision hematoma in 1 case，epidural hematoma，low molecular heparin induced thrombocytopenia did not appear.Conclusion Caprini scale was taken to spinal postoperative VTE risk classification and individualized prevention according to the grading.All patients with spine surgery take physical prevention combined with anticoagulation drugs to guard against VTE.The results revealed that incidence of DVT was comparatively lower and main type was less dangerous plexus venosus leg muscle thrombosis.In the research，incision errhysis occurred in 4 cases，incision hematoma in 1 case.Besides，no epidural bleeding induced nerve injury symptoms and low molecular heparin induced thrombocytopenia happened.Therefore，we can preliminarily consider the preventive solution of this research to be a safe and effective therapy in postoperative thromboembolism prophylaxis for spinal surgery patients.

Key words： spine surgery venous thromboembolism risk factors chemical prevention

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［1］Kanchanabat B，Stapanavatr W，Meknavin S，et al.Systematic review and meta-analysis on the rate of postoperative venous thromboembolism in orthopaedic surgery in Asian patients without thromboprophylaxis［J］.Br J Surg，2011，98(10)：1356-1364.
［2］Glotzbecker MP，Bono CM，Wood KB，et al.Thromboembolic disease in spinal surgery：a systematic review［J］.Spine(Phila Pa 1976)，2009，34(3)：291-303.
［3］Yamaguchi T，Hasegawa M，NⅡmi R，et al.Incidence and time course of asymptomatic deep vein thrombosis with fondaparinux in patients undergoing total joint arthroplasty［J］.Thrombosis Res，2010，126(4)：323-326.
［4］Epstein NE，Staszewski H，Garrison M，et al.Pulmonary embolism diagnosed on computed tomography contrast angiography despite negative venous Doppler ultrasound after spinal surgery［J］.J Spinal Disord Tech，2011，24(6)：358-362.
［5］Cunningham JE，Swamy G，Thomas KC.Does preoperative DVT chemoprophylaxis in spinal surgery affect the incidence of thromboembolic complications and spinal epidural hematomas［J］.J Spinal Disord Tech，2011，24(4)：31-34.
［6］McClendon J，Jr.O’Shaughnessy BA，Smith TR，et al.Comprehensive assessment of prophylactic preoperative inferior vena cava filters for major spinal reconstruction in adults［J］.Spine (Phila Pa 1976)，2012，37(13)：1122-1129.
［7］Caprini JA.Risk assessment as a guide to thrombosis prophylaxis［J］.Curr Opin Pulm Med，2010，16(5)：448-452.
［8］姜玉新，李建初.周围血管和浅表器官超声鉴别诊断图谱［M］.南昌：江西科学技术出版社，2006：65.
［9］田伟.中国骨科大手术静脉血栓栓塞症预防指南［J］.中华骨科杂志，2016，36(2)：65-71.
［10］Ferree BA，Wright AM.Deep venous thrombosis following posterior lumbar spinal surgery［J］.Spine，1993，18(8)：1079-1082.
［11］Wood KB，Kos PB，Abnet JK，et al.Prevention of deep-vein thrombosis after major spinal surgery：a comparison study of external devices［J］.J Spinal Disord，1997，10(3)：209-214.
［12］Lee HM，Suk KS，Moon SH，et al.Deep vein thrombosis after major spinal surgery：incidence in an East Asian population［J］.Spine( Phila Pa1976)，2000，25(14)：1827-1830.
［13］Fineberg SJ，Oglesby M，Patel AA，et al.The incidence and mortality of thromboembolic events in lumbar spine surgery［J］.Spine，2013，38(16)：1154-1159.
［14］Cox JB，Weaver KJ，Neal DW，et al.Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis［J］.J Neurosurg Spine，2014，21(4)：677-684.
［15］Menon V，Harrington RA，Hochman JS，et al.Thrombolysis and adjunctive therapy in acute myocardial infarction：the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy［J］.Chest，2004，126(3 Suppl)：549-575.
［16］Cox JB，Weaver KJ，Neal DW，et al.Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis：Clinical article［J］.J Neurosurg Spine，2014，21(4)：677-684.
［17］Kim DY，Kobayashi L，Chang D，et al.Early pharmacological venous thromboembolism prophylaxis is safe after operative fixation of traumatic spine fractures［J］.Spine (Phila Pa 1976)，2015，40(5)：299-304.
［18］Rojas-Tomba F，Gormaz-Talavera I，Menéndez-Quintanilla IE，et al.Incidence and risk factors of venous thromboembolism in major spinal surgery with no chemical or mechanical prophylaxis［J］.Rev Esp Cir Ortop Traumatol，2016，60(2)：133-140.
［19］Ruppert A，Steinle T，Lees M.Economic burden of venous thromboembolism：a systematic review［J］.J Med Econ，2011，14(1)：65-74.
［20］Glotzbecker MP，Bono CM，Wood KB，et al.Thromboembolic disease in spinal surgery：a systematic review［J］.Spine，2009，34(3)：291-303.
［21］Rosencher N，Bonnet MP，Sessler DI.Selected new antithrombotic agents and neuraxial anaesthesia for major orthopaedic surgery：management strategies［J］.Anaesthesia，2007，62(11)：1154-1160.
［22］Charen DA，Qian ET，Hutzler LH，et al.Risk factors for postoperative venous thromboembolism in orthopaedic spine surgery，hip arthroplasty，and knee arthroplasty patients［J］.Bull Hosp Jt Dis (2013)，2015，73(3)：198-203.
［23］Muntz J.Thromboprophylaxis in orthopedic surgery：how long is long enough［J］.Am J Orthop ( Belle Mead NJ)，2009，38(8)：394-401.
［24］Gould MK，Garcia DA，Wren SM.Prevention of VTE in nonorthopedic surgical patients：American College of Chest Physicians evidence-based clinical practice guidelines［J］.Chest，141(2)：227-277.
［25］Warwick D，Rosencher N.Thecritical thrombosis periodin major orthopedic surgery：when to start and when to stop prophylaxis［J］.Clin Appl Thromb Hemost，2010，16(4)：394-405.
［26］Charen DA，Qian ET，Hutzler LH，et al.Risk factors for postoperative venous thromboembolism in orthopaedic spine surgery，hip arthroplasty，and knee arthroplasty patients［J］.Bull Hosp Jt Dis (2013)，2015，73(3)：198-203.
［27］Hamidi S，Riazi M.Cutoff values of plasma d-dimer level in patients with diagnosis of the venous thromboembolism after elective spinal surgery［J］.Asian Spine J，2015，9(2)：232-238.
［28］Kim DY，Kobayashi L，Chang D，et al.Early pharmacological venous thromboembolism prophylaxis is safe after operative fixation of traumatic spine fractures［J］.Spine (Phila Pa 1976)，2015，40(5)：299-304.

[1]	. [J]. sygkzz, 2021, 27(3): 254-257.