Tischler Eric H, Ponzio Danielle Y, Diaz-Ledezma Claudio, Parvizi Javad
The Rothman Institute, Philadelphia, Pennsylvania - USA.
Hip Int. 2014 Jan-Feb;24(1):77-80. doi: 10.5301/hipint.5000079. Epub 2013 Aug 9.
As hip-preservation surgery is performed in a particularly young and active group of patients, the knowledge accrued in the fields of hip arthroplasty and hip fracture care regarding postoperative thromboprophylaxis cannot be extrapolated to this patient population. Recommendations based on the evidence for each particular surgical procedure and population is desirable. For these reasons, the purpose of our study is to describe the rate of clinically relevant venous thromboembolism (VTE) and anticoagulation-related complications observed in patients undergoing hip-preservation surgery through mini-open femoracetabular osteoplasty (FAO) with a formal postoperative thromboprophylaxis protocol of aspirin dosing.
A prospective case series of 407 consecutive FAO procedures in 375 patients of mean age 34.5 ± 11.1 years (range 15-62 years) were followed six weeks post operatively to document the presence of clinically relevant VTE as well as major bleeding events, as defined by the most recent American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. All patients were given aspirin 325 mg by mouth daily for two to four weeks.
There was one case of distal DVT in a 31-year-old male with no specific risk factors. No cases of pulmonary embolism were observed. There were no major bleeding events or reoperations due to postsurgical haematoma. There were no deaths. The crude incidence of clinically relevant VTE was 1 per 407 procedures (0.25%).
Aspirin is a safe and effective modality to provide thromboprophylaxis in patients undergoing hip-preservation surgery. The rate of VTE that we observed is, thus far, the lowest in comparison to other published series of hip preservation surgery that specifically focused on this complication.
由于保髋手术主要针对的是年轻且活动量大的患者群体，髋关节置换术和髋部骨折护理领域积累的术后血栓预防知识不能直接应用于该患者群体。基于每种特定手术程序和人群的证据提出建议是很有必要的。出于这些原因，我们研究的目的是描述通过小切口股骨髋臼截骨术（FAO）进行保髋手术且采用正式的术后阿司匹林剂量血栓预防方案的患者中，临床相关静脉血栓栓塞（VTE）和抗凝相关并发症的发生率。
对375例平均年龄34.5±11.1岁（范围15 - 62岁）的患者进行了407例连续FAO手术的前瞻性病例系列研究，术后六周随访，以记录临床相关VTE以及根据美国胸科医师学会最新循证临床实践指南定义的重大出血事件的发生情况。所有患者每天口服325毫克阿司匹林，持续两到四周。
一名31岁男性无特定危险因素发生了一例远端深静脉血栓。未观察到肺栓塞病例。没有因术后血肿导致的重大出血事件或再次手术。无死亡病例。临床相关VTE的粗发病率为每407例手术1例（0.25%）。
阿司匹林是为接受保髋手术的患者提供血栓预防的一种安全有效的方式。与其他专门关注该并发症的已发表的保髋手术系列相比，我们观察到的VTE发生率是迄今为止最低的。
