Yu Zheng-rong, Li Chun-de, Yi Xiao-dong, Lin Jing-rong, Liu Xian-yi, Liu Hong, Lu Hai-lin
Department of Orthopedics, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2011 Oct 18;43(5):661-5.
To investigate the efficacy and safety of venous thrombus embolism (VTE) prophylaxis according to risk stratifications after spinal surgery.
From June 2008 to June 2009, we separated 298 spinal patients who had different VTE risk factors into low-, medium- and high-risk groups for 22 cases, 48 cases and 228 cases respectively. Physical prevention measures such as thigh-length thromboembolic deterrent stockings (TEDS) and pneumatic sequential compression device (PSCD) were used in low- and medium-risk groups. In high-risk groups, low molecular weight heparin(LMWH) was applied in addition to physical prevention measures. Lower limb vascular doppler ultrasonography was used to monitor thrombosis pre- and postoperatively. Simultaneously the occurrences of epidural or wound hematoma, mucosal bleeding, thrombocytopenia caused by low molecular heparin and nerve damage caused by extradural hemorrhage were monitored.
Among the 298 cases of patients with spinal surgery, DVT occurred in 23 cases, the incidence of DVT was 7.7%. There were 0, 2 and 21 patients with positive findings of deep vein thrombosis on duplex ultrasonograph respectively in low-, medium- and high-risk groups. There was no case of PE. All DVT was thrombosis in calf which was distal to the knee. There was no clinical symptom of VTE. The DVT needed no therapy. The vein with thrombosis was recanalized 3 months after operation. No case caught epidural or wound hematoma, mucosal bleeding, thrombocytopenia caused by low molecular heparin or nerve damage caused by extradural hemorrhage.
Individual VTE prophylaxis was taken according to risk stratifications. No VTE of clinical value or no complications from prophylaxis happened. So our prophylaxis is effective and safe. But more prospective, case-control studies are needed to assess the efficacy and safety of VTE prophylaxis.
探讨脊柱手术后根据风险分层进行静脉血栓栓塞症（VTE）预防的有效性和安全性。
2008年6月至2009年6月，我们将298例具有不同VTE风险因素的脊柱手术患者分为低、中、高风险组，分别为22例、48例和228例。低、中风险组采用大腿长度的血栓栓塞预防袜（TEDS）和气圈式循序减压装置（PSCD）等物理预防措施。高风险组除物理预防措施外，还应用低分子量肝素（LMWH）。采用下肢血管多普勒超声监测术前和术后血栓形成情况。同时监测硬膜外或伤口血肿、黏膜出血、低分子肝素引起的血小板减少以及硬膜外出血引起的神经损伤的发生情况。
298例脊柱手术患者中，23例发生深静脉血栓（DVT），DVT发生率为7.7%。低、中、高风险组双功超声检查深静脉血栓阳性分别为0例、2例和21例。无肺栓塞（PE）病例。所有DVT均为膝以下小腿部血栓形成。无VTE临床症状。DVT无需治疗。术后3个月血栓形成的静脉再通。未发生硬膜外或伤口血肿、黏膜出血、低分子肝素引起的血小板减少或硬膜外出血引起的神经损伤。
根据风险分层进行个体化VTE预防。未发生具有临床意义的VTE或预防并发症。因此，我们的预防措施是有效和安全的。但需要更多前瞻性病例对照研究来评估VTE预防的有效性和安全性。
