Saraf Shyam K, Rana Raj Jb, Sharma Om P
Department of Orthopedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Indian J Orthop. 2007 Jul;41(3):194-7. doi: 10.4103/0019-5413.33681.
The western literature on deep vein thrombosis (DVT) and pulmonary embolism (PE) following spinal cord injury (SCI) report an alarmingly high incidence, necessitating thromboprophylaxis. The literature on incidence from the Asian subcontinent is scanty and from India is almost nonexistent.
Seventy hospitalized acute SCI patients presenting within five days of the injury were included in the present analysis. Forty-two cases were subjected to color Doppler studies and 28 cases had to be subjected to venography due to lack of facility at some point of time. The clinical course of the patients was closely observed during the period of hospitalization. All except 14 were managed nonoperatively. Thromboprophylaxis was not given to any patient at any stage; however, treatment was instituted in those showing the features of DVT on investigations.
Twelve patients died during the period of hospitalization. Deep vein thrombosis could be detected in seven patients only, three in the proximal and four in the distal segment of the lower limb and of these three died. Based on the clinical course and positive investigation report in favor of DVT, we presumed that the cause of death in these three patients was pulmonary embolism. In the other nine, in the absence of an autopsy report, the cause of deaths was considered as pulmonary infection, asphyxia, diaphragmatic paralysis, hematemesis, cervicomedullary paralysis etc. Clinical features to diagnose DVT were of little help.
There is a much lower incidence (10%) of DVT and PE following spinal cord injury (SCI) in India than what is reported from the western countries. Higher age group and quadriplegia were the only factors which could be correlated. Deep vein thrombosis extending proximal to the knee was significant. In the absence of autopsy and other screening tests like D-dimer test or 125I fibrogen uptake study, the true incidence of venous thromboembolism remains uncertain. Noninvasive screening of all patients for the detection of deep vein thrombosis in SCI patients is strongly recommended.
西方关于脊髓损伤（SCI）后深静脉血栓形成（DVT）和肺栓塞（PE）的文献报道其发病率高得惊人，因此有必要进行血栓预防。来自亚洲次大陆的发病率文献较少，而来自印度的几乎不存在。
本分析纳入了70例在受伤后5天内住院的急性SCI患者。42例接受了彩色多普勒检查，28例因某些时候缺乏设备而不得不接受静脉造影。在住院期间密切观察患者的临床病程。除14例患者外，其余均采用非手术治疗。在任何阶段均未对任何患者进行血栓预防；然而，对检查显示有DVT特征的患者进行了治疗。
12例患者在住院期间死亡。仅在7例患者中检测到深静脉血栓形成，其中3例位于下肢近端，4例位于下肢远端，这3例患者死亡。根据临床病程和支持DVT的阳性检查报告，我们推测这3例患者的死亡原因是肺栓塞。在另外9例患者中，由于没有尸检报告，死亡原因被认为是肺部感染、窒息、膈肌麻痹、呕血、颈髓麻痹等。诊断DVT的临床特征帮助不大。
印度脊髓损伤（SCI）后深静脉血栓形成（DVT）和肺栓塞（PE）的发病率（10%）远低于西方国家的报道。年龄较大和四肢瘫痪是仅有的可相关因素。深静脉血栓延伸至膝部近端具有重要意义。由于缺乏尸检和其他筛查试验，如D - 二聚体试验或125I纤维蛋白原摄取研究，静脉血栓栓塞的真实发病率仍不确定。强烈建议对所有脊髓损伤患者进行无创筛查以检测深静脉血栓形成。
