血栓栓塞事件在使用阿司匹林和压缩装置进行肱骨近端骨折的开放性治疗后并不常见。
Thromboembolic events are uncommon after open treatment of proximal humerus fractures using aspirin and compression devices.
机构信息
University of Pennsylvania Health System, 3B Orthopaedics, Pennsylvania Hospital/Lankenau Hospital, 800 Spruce Street, 8th Floor Preston, Philadelphia, PA 19107, USA.
出版信息
Clin Orthop Relat Res. 2011 Dec;469(12):3332-6. doi: 10.1007/s11999-011-1942-7.
BACKGROUND
Thromboembolic phenomena have long been recognized as a major cause of morbidity and mortality in hospitalized patients, especially those undergoing reconstructive surgery. We have been empirically treating patients with aspirin, early ambulation, and mechanoprophylaxis after operative management of proximal humerus fractures. However, we have not established the incidence of postoperative deep vein thrombosis and pulmonary embolism in this population.
QUESTIONS/PURPOSES: We determined the incidence of deep vein thrombosis and pulmonary embolism in patients having surgery for displaced proximal humerus fractures treated with our thromboprophylactic regimen.
PATIENTS AND METHODS
We prospectively followed 50 patients with proximal humerus fractures who underwent fixation with plate osteosynthesis (n = 40) or hemiarthroplasty (n = 10) between August 2005 and December 2008. Deep vein thrombosis prophylaxis consisted of oral enteric-coated aspirin, pneumatic calf compression pumps, and early ambulation in all patients unless medically contraindicated. Color-flow Doppler ultrasound of the affected arm and both lower extremities was performed at a mean of 14 days (range, 7-21 days) postoperatively to evaluate for deep vein thrombosis. All patients clinically suspected to have suffered a pulmonary embolism underwent a CT angiogram.
RESULTS
We identified no patients with deep vein thrombosis or pulmonary embolism in this population.
CONCLUSIONS
Deep vein thrombosis and pulmonary embolism are not uncommon after major reconstructive surgery about the shoulder in untreated patients. Our data suggest these events can be low after surgery for proximal humerus fractures followed by a thromboprophylactic regimen including aspirin, mechanical devices, and early mobilization.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
血栓栓塞现象长期以来一直被认为是住院患者，尤其是接受重建手术患者发病率和死亡率的主要原因。我们一直在凭经验用阿司匹林、早期活动和机械预防措施来治疗接受肱骨头近端骨折手术治疗的患者。但是，我们尚未确定该人群术后深静脉血栓形成和肺栓塞的发生率。
问题/目的：我们确定了使用我们的血栓预防方案治疗移位性肱骨头近端骨折患者手术后深静脉血栓形成和肺栓塞的发生率。
患者和方法
我们前瞻性地随访了 2005 年 8 月至 2008 年 12 月期间接受钢板内固定术（n = 40）或人工半关节置换术（n = 10）治疗的 50 例肱骨头近端骨折患者。所有患者均接受口服肠溶阿司匹林、气动小腿压缩泵和早期活动的深静脉血栓形成预防，除非有医学禁忌。术后平均 14 天（范围 7-21 天）对受累手臂和双侧下肢行彩色多普勒超声检查，以评估深静脉血栓形成情况。所有临床上疑似患有肺栓塞的患者均进行 CT 血管造影。
结果
在该人群中，我们未发现深静脉血栓形成或肺栓塞患者。
结论
在未治疗的患者中，肩部大重建手术后深静脉血栓形成和肺栓塞并不少见。我们的数据表明，接受肱骨头近端骨折手术后，采用包括阿司匹林、机械装置和早期活动在内的血栓预防方案，这些事件的发生率可能较低。
证据等级
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
Zotero 插件