Lapidus Lasse J, Ponzer Sari, Pettersson Hans, de Bri Edin
BMC Musculoskelet Disord. 2013 Jun 4;14:177. doi: 10.1186/1471-2474-14-177.
Little information exists on the presentation of symptomatic venous thromboembolism (VTE) in orthopaedic surgery when a defined protocol for thromboprophylaxis is used. The objective with this study was to establish the VTE rate and mortality rate in orthopaedic surgery.
We performed a prospective, single centre observational cohort study of 45 968 consecutive procedures in 36 388 patients over a 10 year period. Follow-up was successful in 99.3%. The primary study outcome was the incidence of symptomatic deep vein thrombosis (DVT), symptomatic pulmonary embolism (PE) and mortality at 6 weeks, specified for different surgical procedures. The secondary outcome was to describe the DVT distribution in proximal and distal veins and the proportion of VTEs diagnosed after hospital discharge. For validation purposes, a retrospective review of VTEs diagnosed 7-12 weeks postoperatively was also performed.
In total, 514 VTEs were diagnosed (1.1%; 95% CI: 1.10-1.14), the majority (84%) after hospital discharge (432 out of 514).With thromboprophylaxis, high incidence of VTE was found after internal fixation (IF) of pelvic fracture (12%; 95% CI: 5-26), knee replacement surgery (3.7%; 95% CI: 2.8-5.0), after internal fixation (IF) of proximal tibia fracture (3.8%; 95% CI: 2.3-6.3) and after IF of ankle fracture (3.6%; 95% CI: 2.9-4.4). Without thromboprophylaxis, high incidence of VTE was found after Achilles tendon repair (7.2%; 95% CI: 5.5-9.4). In total 1094 patients deceased (2.4%; 95% confidence interval (CI): 2.33- 2.44) within 6 weeks of surgery. Highest mortality was seen after lower limb amputation (16.3%, CI: 13.8-19.1) and after hip hemiarthroplasty due to hip fracture (9.6%, CI; 7.6-12.1).
The overall incidence of VTE is low after orthopaedic surgery but our study highlights surgical procedures after which the risk for VTE remains high and improved thromboprophylaxis is needed.
在采用特定血栓预防方案的骨科手术中，关于症状性静脉血栓栓塞症（VTE）的表现信息较少。本研究的目的是确定骨科手术中的VTE发生率和死亡率。
我们在10年期间对36388例患者连续进行的45968例手术进行了一项前瞻性、单中心观察性队列研究。随访成功率为99.3%。主要研究结局是6周时症状性深静脉血栓形成（DVT）、症状性肺栓塞（PE）的发生率以及死亡率，按不同手术类型进行明确。次要结局是描述DVT在近端和远端静脉中的分布情况以及出院后诊断出的VTE比例。为进行验证，还对术后7 - 12周诊断出的VTE进行了回顾性分析。
总共诊断出514例VTE（1.1%；95%置信区间：1.10 - 1.14），其中大多数（84%）在出院后（514例中的432例）。在进行血栓预防的情况下，骨盆骨折内固定（IF）术后VTE发生率较高（12%；95%置信区间：5 - 26），膝关节置换术后（3.7%；95%置信区间：2.8 - 5.0），胫骨近端骨折内固定（IF）术后（3.8%；95%置信区间：2.3 - 6.3）以及踝关节骨折IF术后（3.6%；95%置信区间：2.9 - 4.4）。在未进行血栓预防的情况下，跟腱修复术后VTE发生率较高（7.2%；95%置信区间：5.5 - 9.4）。共有1094例患者在术后6周内死亡（2.4%；95%置信区间（CI）：2.33 - 2.44）。下肢截肢术后死亡率最高（16.3%，CI：13.8 - 19.1），因髋部骨折行半髋关节置换术后死亡率为9.6%（CI；7.6 - 12.1）。
骨科手术后VTE的总体发生率较低，但我们的研究突出了哪些手术术后VTE风险仍然较高，需要改进血栓预防措施。
