Vanderbilt Orthopaedic Institute, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774, USA.
J Bone Joint Surg Am. 2011 May 4;93(9):847-54. doi: 10.2106/JBJS.H.01640.
As both cancer and major orthopaedic surgery are risk factors for venous thromboembolism, patients undergoing lower-extremity oncologic endoprosthetic arthroplasty for neoplastic processes are at substantial risk of the development of symptomatic venous thromboembolism. Therefore, the primary purpose of this study was to determine the incidence of symptomatic venous thromboembolism in patients undergoing lower-extremity oncologic endoprosthetic arthroplasty. Secondary purposes were to assess whether chemoprophylaxis influenced the incidence of venous thromboembolism, surgical complications, or the incidence of local sarcoma recurrence. We also sought to determine whether any known risk factors for venous thromboembolism could be identified in this patient population.
We performed a retrospective comparative review of 423 patients who had undergone mega-endoprosthetic reconstruction following cancer resection. Univariate analysis was used to assess the association between chemoprophylaxis and the incidence of venous thromboembolism, to postulate the surgical complications associated with chemoprophylaxis, and to assess the rate of recurrence of local sarcoma as well the association between risk factors and venous thromboembolism.
Seventeen patients (4.0%) (95% confidence interval: 2.5% to 6.3%) had a venous thromboembolic event, ten with deep venous thrombosis and seven with nonfatal pulmonary embolism. Risk factors and chemoprophylactic regimens were not statistically associated with the occurrence of venous thromboembolism.
The incidence of symptomatic venous thromboembolism in our group of cancer patients who underwent lower-extremity endoprosthetic arthroplasty was lower than anticipated. A significant difference was not identified between the use of any or no chemoprophylactic agent and the incidence of venous thromboembolism or complication rates. No risk factors were associated with the incidence of symptomatic venous thromboembolism.
由于癌症和主要骨科手术都是静脉血栓栓塞症的危险因素，因此接受下肢恶性肿瘤假体关节置换术的患者有发生症状性静脉血栓栓塞症的高风险。因此，本研究的主要目的是确定接受下肢恶性肿瘤假体关节置换术的患者发生症状性静脉血栓栓塞症的发生率。次要目的是评估化学预防是否影响静脉血栓栓塞症、手术并发症或局部肉瘤复发的发生率。我们还试图确定在这一患者群体中是否可以确定任何已知的静脉血栓栓塞症危险因素。
我们对 423 例接受恶性肿瘤切除后行 Mega 假体重建的患者进行了回顾性对比分析。采用单因素分析评估化学预防与静脉血栓栓塞症发生率之间的关系，推测与化学预防相关的手术并发症，并评估局部肉瘤复发率以及危险因素与静脉血栓栓塞症之间的关系。
17 例（4.0%）（95%置信区间：2.5%至 6.3%）患者发生静脉血栓栓塞事件，10 例为深静脉血栓形成，7 例为非致命性肺栓塞。危险因素和化学预防方案与静脉血栓栓塞症的发生无统计学关联。
我们组接受下肢假体关节置换术的癌症患者发生症状性静脉血栓栓塞症的发生率低于预期。使用任何一种或不使用化学预防药物与静脉血栓栓塞症的发生率或并发症发生率之间没有显著差异。没有危险因素与症状性静脉血栓栓塞症的发生相关。
