Jameson S S, Augustine A, James P, Serrano-Pedraza I, Oliver K, Townshend D, Reed M R
Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.
J Bone Joint Surg Br. 2011 Apr;93(4):490-7. doi: 10.1302/0301-620X.93B4.25731.
Diagnostic and operative codes are routinely collected for every patient admitted to hospital in the English NHS. Data on post-operative complications following foot and ankle surgery have not previously been available in large numbers. Data on symptomatic venous thromboembolism events and mortality within 90 days were extracted for patients undergoing fixation of an ankle fracture, first metatarsal osteotomy, hindfoot fusions and total ankle replacement over a period of 42 months. For ankle fracture surgery (45 949 patients), the rates of deep-vein thrombosis (DVT), pulmonary embolism and mortality were 0.12%, 0.17% and 0.37%, respectively. For first metatarsal osteotomy (33 626 patients), DVT, pulmonary embolism and mortality rates were 0.01%, 0.02% and 0.04%, and for hindfoot fusions (7033 patients) the rates were 0.03%, 0.11% and 0.11%, respectively. The rate of pulmonary embolism in 1633 total ankle replacement patients was 0.06%, and there were no recorded DVTs and no deaths. Statistical analysis could only identify risk factors for venous thromboembolic events of increasing age and multiple comorbidities following fracture surgery. Venous thromboembolism following foot and ankle surgery is extremely rare, but this subset of fracture patients is at a higher risk. However, there is no evidence that thromboprophylaxis reduces this risk, and these national data suggest that prophylaxis is not required in most of these patients.
在英国国民医疗服务体系（NHS）中，每位住院患者都会常规收集诊断和手术编码。此前，尚无大量关于足踝手术后并发症的数据。我们提取了42个月内接受踝关节骨折固定术、第一跖骨截骨术、后足融合术和全踝关节置换术患者的有症状静脉血栓栓塞事件及90天内死亡率的数据。对于踝关节骨折手术（45949例患者），深静脉血栓形成（DVT）、肺栓塞和死亡率分别为0.12%、0.17%和0.37%。对于第一跖骨截骨术（33626例患者），DVT、肺栓塞和死亡率分别为0.01%、0.02%和0.04%，对于后足融合术（7033例患者），相应比率分别为0.03%、0.11%和0.11%。1633例全踝关节置换患者的肺栓塞发生率为0.06%，未记录到DVT事件，也无死亡病例。统计分析仅能确定骨折手术后静脉血栓栓塞事件的危险因素为年龄增长和多种合并症。足踝手术后的静脉血栓栓塞极为罕见，但这部分骨折患者风险较高。然而，没有证据表明血栓预防可降低这种风险，这些全国性数据表明大多数此类患者无需进行预防。
