Niikura Takahiro, Lee Sang Yang, Oe Keisuke, Koh Akihiro, Koga Takaaki, Dogaki Yoshihiro, Okumachi Etsuko, Kurosaka Masahiro
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
J Orthop Sci. 2012 May;17(3):233-8. doi: 10.1007/s00776-012-0203-2. Epub 2012 Mar 20.
There are no detailed reports of the incidence of venous thromboembolism (VTE) in pelvic and acetabular fractures in the Asian population. The purpose of this study was to investigate the incidence of VTE in pelvic and acetabular fractures in the Japanese population.
Forty-six Japanese patients with pelvic and acetabular fractures treated at our hospital from February 2004 to April 2011 were analyzed retrospectively. Until April 2009, VTE screening was performed by contrast-enhanced computed tomography (CT) or ultrasonography (US) when the D-dimer value did not decline predictably, still exceeded 20 µg/ml at 5 days after trauma and surgery, or increased >20 µg/ml after a period of decline. After April 2009, contrast-enhanced CT and US were performed routinely irrespective of the D-dimer value. Physical prophylaxis was performed in all patients. The effects of the presence of pelvic and acetabular fractures, fracture types, accompanying injuries, and screening strategies on the incidences of VTE and pulmonary thromboembolism (PTE) were investigated.
Overall, 19 patients (41.3%) were diagnosed with VTE and PTE in ten (21.7%). All were asymptomatic. Compared with trauma patients without pelvic and acetabular fractures treated during the same period, significantly higher incidences of VTE and PTE were observed in patients with pelvic and acetabular fractures. No significant differences were observed in the incidences of VTE and PTE between pelvic and acetabular fractures or between patients with and without accompanying injuries. Compared with the previous screening strategy, the detection rates of VTE and PTE were higher for the newer screening strategy; however, the difference did not reach statistical significance.
We should be vigilant for the high incidence of VTE, especially PTE, in patients with pelvic and acetabular fractures in the Japanese population.
亚洲人群中骨盆和髋臼骨折后静脉血栓栓塞症（VTE）的发病率尚无详细报道。本研究旨在调查日本人群中骨盆和髋臼骨折后VTE的发病率。
回顾性分析2004年2月至2011年4月在我院接受治疗的46例日本骨盆和髋臼骨折患者。在2009年4月之前，当D - 二聚体值未呈预期下降、创伤和手术后5天仍超过20μg/ml或在下降一段时间后升高>20μg/ml时，通过增强计算机断层扫描（CT）或超声检查（US）进行VTE筛查。2009年4月之后，无论D - 二聚体值如何，均常规进行增强CT和US检查。所有患者均进行物理预防。研究骨盆和髋臼骨折的存在、骨折类型、伴随损伤及筛查策略对VTE和肺血栓栓塞症（PTE）发病率的影响。
总体而言，19例患者（41.3%）被诊断为VTE，10例（21.7%）被诊断为PTE。所有患者均无症状。与同期未发生骨盆和髋臼骨折的创伤患者相比，骨盆和髋臼骨折患者的VTE和PTE发病率显著更高。骨盆骨折与髋臼骨折之间或有伴随损伤与无伴随损伤患者之间的VTE和PTE发病率无显著差异。与先前的筛查策略相比，新筛查策略的VTE和PTE检出率更高；然而，差异未达到统计学意义。
我们应警惕日本人群中骨盆和髋臼骨折患者VTE尤其是PTE的高发病率。
