Mitchell Sheryl Y, Lingard Elizabeth A, Kesteven Patrick, McCaskie Andrew W, Gerrand Craig H
Departments of Orthopaedics, Freeman Hospital, Newcastle Upon Tyne, NE7 7DN, England.
J Bone Joint Surg Am. 2007 Nov;89(11):2433-9. doi: 10.2106/JBJS.F.01308.
Venous thromboembolism has been independently associated with both malignant disease and orthopaedic surgery. Patients with bone or soft-tissue tumors who undergo orthopaedic surgery may therefore be at high risk for thromboembolic events. The purpose of the present retrospective study was to determine the rate of clinically detected deep venous thrombosis and pulmonary embolism in patients with trunk or extremity bone or soft-tissue sarcomas.
The medical records of patients with a confirmed diagnosis of primary bone or soft-tissue sarcoma who had presented to our unit between 1998 and 2003 were reviewed with use of a standardized chart abstraction tool. The data that were retrieved included patient-related data (demographic characteristics, diagnoses, and surgical interventions), the use of adjuvant chemotherapy or radiation therapy, additional risk factors for thromboembolism, the use of thromboembolic prophylaxis, and confirmed thromboembolic events.
Of the 252 patients who were identified, ninety-four had a diagnosis of primary bone sarcoma and 158 had a diagnosis of primary soft-tissue sarcoma. Approximately 70% of the cohort received thromboprophylaxis, with 57% receiving low-molecular-weight heparin. Thirty-seven patients were clinically suspected of having a deep venous thrombosis. Nine patients had a deep venous thrombosis that was confirmed radiographically, and in one case the diagnosis was made at another center, resulting in a rate of clinically evident deep venous thrombosis of 4%. Nine patients had a clinically suspected pulmonary embolism. One patient had confirmation of the pulmonary embolism with use of a ventilation-perfusion scan, one patient died of pulmonary embolism, and one patient had diagnosis of the pulmonary embolism at another center, resulting in an overall rate of pulmonary embolism of 1.2% and a rate of fatal pulmonary embolism of 0.4%. All patients with thromboembolic events had a tumor involving the hip or thigh, with the majority of the events occurring prior to definitive surgery.
The risk of a clinically apparent thromboembolic event in patients with bone or soft-tissue sarcomas is comparable with that in other orthopaedic patients. However, tumors in the hip or thigh may be associated with a particularly high risk of thromboembolism. A prospective study is needed to investigate factors that are predictive of thromboembolism and the role of chemical thromboprophylaxis.
静脉血栓栓塞症与恶性疾病和骨科手术均独立相关。因此，接受骨科手术的骨或软组织肿瘤患者可能发生血栓栓塞事件的风险较高。本回顾性研究的目的是确定躯干或四肢骨或软组织肉瘤患者临床诊断的深静脉血栓形成和肺栓塞发生率。
使用标准化图表提取工具，回顾了1998年至2003年间到我院就诊且确诊为原发性骨或软组织肉瘤患者的病历。检索的数据包括患者相关数据（人口统计学特征、诊断和手术干预）、辅助化疗或放疗的使用情况、血栓栓塞的其他危险因素、血栓栓塞预防措施的使用情况以及确诊的血栓栓塞事件。
在确定的252例患者中，94例诊断为原发性骨肉瘤，158例诊断为原发性软组织肉瘤。大约70%的队列接受了血栓预防，其中57%接受低分子量肝素治疗。37例患者临床怀疑有深静脉血栓形成。9例患者经影像学证实有深静脉血栓形成，1例在其他中心确诊，导致临床明显深静脉血栓形成率为4%。9例患者临床怀疑有肺栓塞。1例患者经通气灌注扫描确诊为肺栓塞，1例患者死于肺栓塞，1例患者在其他中心诊断为肺栓塞，导致肺栓塞总发生率为1.2%，致命性肺栓塞发生率为0.4%。所有发生血栓栓塞事件的患者肿瘤均累及髋部或大腿，大多数事件发生在确定性手术之前。
骨或软组织肉瘤患者发生临床明显血栓栓塞事件的风险与其他骨科患者相当。然而，髋部或大腿的肿瘤可能与特别高的血栓栓塞风险相关。需要进行前瞻性研究以调查预测血栓栓塞的因素以及化学血栓预防的作用。
