Wukich Dane K, Waters Dana H
Foot and Ankle Division, University of Pittsburgh Medical Center, Department of Orthopaedic Surgery, UPMC Comprehensive Foot and Ankle Center, Pittsburgh, PA 15203, USA.
J Foot Ankle Surg. 2008 May-Jun;47(3):243-9. doi: 10.1053/j.jfas.2008.02.003. Epub 2008 Mar 28.
Venous thromboembolism following major orthopedic procedures of the hip and knee is well documented and patients are therefore routinely prophylaxed following these proximal lower extremity procedures. In contrast, foot and ankle surgery is considered by most health care professionals to be a low-risk procedure for the development of venous thromboembolism. As a result, pharmacologic deep venous thrombosis prophylaxis is rarely administered. This postoperative practice is supported by the literature regarding deep venous thrombosis following foot and ankle surgery. In this article, we review the risk factors and explore the occurrence of thromboembolism after foot and ankle surgery in the literature. We also present our retrospective study of patients who developed venous thromboembolism after forefoot, midfoot, hindfoot, and ankle procedures. Over the course of 1.5 years, 4 of a consecutive series of 1000 patients (0.4%) developed a deep venous thrombolism and 3 of 1000 (0.3%) developed nonfatal pulmonary emboli. In our series, each of our patients who developed venous thromboembolism had at least 2 identifiable risk factors. The incidence of venous thromboembolism following foot and ankle surgery is rare (less than 1%), and the need for routine propylaxis postoperatively is not supported by any high level of evidence studies.
髋部和膝部的大型骨科手术后发生静脉血栓栓塞已有充分记录，因此在这些下肢近端手术后患者通常会接受预防性治疗。相比之下，大多数医疗保健专业人员认为足踝手术发生静脉血栓栓塞的风险较低。因此，很少进行药物性深静脉血栓形成预防。足踝手术后深静脉血栓形成的文献支持了这种术后做法。在本文中，我们回顾了风险因素，并探讨了文献中足踝手术后血栓栓塞的发生情况。我们还展示了对在前足、中足、后足和踝关节手术后发生静脉血栓栓塞的患者的回顾性研究。在1.5年的时间里，连续1000例患者中有4例（0.4%）发生了深静脉血栓形成，1000例中有3例（0.3%）发生了非致命性肺栓塞。在我们的系列研究中，每例发生静脉血栓栓塞的患者至少有2个可识别的风险因素。足踝手术后静脉血栓栓塞的发生率很低（低于1%），并且没有任何高水平证据研究支持术后常规预防的必要性。
4级。
