Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue, St. Louis, MO 63110, USA.
J Trauma Acute Care Surg. 2012 Feb;72(2):443-7. doi: 10.1097/TA.0b013e318241090d.
Recent evidence-based practice guidelines recommend against routine ultrasound screening for proximal deep vein thrombosis (DVT) in asymptomatic pelvic fracture patients. However, the majority of trauma surgeons favor this practice. Furthermore, the timing of screening has been inconsistently described. The purpose of this study was to examine the utility of sequential scans in asymptomatic acetabular and pelvic fracture patients treated operatively.
In 2003, a screening protocol for DVT was begun for asymptomatic patients with these fractures treated operatively. Duplex ultrasound screening was used to evaluate the lower extremities for proximal DVT. Scans were to be obtained preoperatively and then postoperatively on the day before planned discharge from the hospital. A DVT prophylaxis protocol was also instituted. Between 2003 and 2007, 343 patients were identified for study. Patients were followed for thromboembolic complications for a minimum of 3 months.
Two hundred twenty-nine patients received both preoperative and postoperative scans. Of these, 35 patients (15%) had an asymptomatic DVT: 16 (7%) preoperatively and 19 (8%) postoperatively. Two patients (1%) with negative scans had a postoperative symptomatic pulmonary embolism (PE) diagnosed the day after surgery, but fatal PE did not occur. In the remaining 114 patients, 27 received a prophylactic inferior vena cava filter, 6 had a preoperative symptomatic DVT or PE before scanning, 25 received only the postoperative scan (3 being positive), and 56 were not scanned postoperatively. Of the 56 not scanned postoperatively, 2 (4%) were readmitted with a symptomatic proximal DVT but none for PE, and a fatal PE did not occur.
Despite the possible diagnostic utility of sequential duplex ultrasound screening, it does not decrease the risk of PE in acetabular and pelvic fracture patients.
IV.
最近的循证实践指南建议，对于无症状骨盆骨折患者，不常规进行近端深静脉血栓（DVT）的超声筛查。然而，大多数创伤外科医生赞成这种做法。此外，筛查的时间也没有一致的描述。本研究的目的是检查连续扫描在接受手术治疗的无症状髋臼和骨盆骨折患者中的应用价值。
2003 年，开始为接受手术治疗的这些骨折的无症状患者制定 DVT 筛查方案。使用双功能超声筛查来评估下肢近端 DVT。术前和计划出院前一天进行扫描。还制定了 DVT 预防方案。在 2003 年至 2007 年期间，确定了 343 名患者进行研究。对患者进行了至少 3 个月的血栓栓塞并发症随访。
229 名患者接受了术前和术后扫描。其中，35 名患者（15%）出现无症状 DVT：术前 16 例（7%），术后 19 例（8%）。2 名（1%）阴性扫描的患者术后第二天诊断出有症状的肺栓塞（PE），但未发生致命性 PE。在其余 114 名患者中，27 名接受了预防性下腔静脉滤器，6 名在扫描前有术前症状性 DVT 或 PE，25 名仅接受了术后扫描（3 例阳性），56 名未接受术后扫描。在 56 名未接受术后扫描的患者中，2 名（4%）因症状性近端 DVT 再次入院，但无 PE 患者，也未发生致命性 PE。
尽管连续双功能超声筛查可能具有诊断效用，但它并不能降低髋臼和骨盆骨折患者发生 PE 的风险。
IV。
