Polkowski Gregory G, Duncan Stephen T, Bloemke Adam D, Schoenecker Perry L, Clohisy John C
Vanderbilt Orthopaedic Institute, Nashville, TN, USA.
Clin Orthop Relat Res. 2014 Aug;472(8):2500-5. doi: 10.1007/s11999-014-3614-x. Epub 2014 Apr 15.
The periacetabular osteotomy has become a common procedure for treating symptomatic acetabular dysplasia. Like other major hip procedures, there is concern regarding the risk of associated venous thromboembolic disease. Nevertheless, there is limited information regarding the need for screening, and optimal prophylactic measures have not been established.
QUESTIONS/PURPOSES: We sought to determine the frequency of thromboembolic events (deep vein thrombosis [DVT] and symptomatic pulmonary embolism [PE]) associated with the periacetabular osteotomy in in patients receiving aspirin and mechanical compression prophylaxis.
We performed a retrospective review of 134 adult patients (149 hips) treated with the periacetabular osteotomy during an 8-year period. During this period, 136 (91%) of the hips treated with a periacetabular osteotomy were screened within 1 week for DVT, whereas 13 (9%) could not be evaluated for various reasons. The mean age of the patients at the time of surgery was 30 years (range, 18-60 years), and no patients were lost to followup during the 4 to 6 months after surgery. The same thromboembolic prophylactic regimen was used for all patients. This consisted of 325 mg aspirin twice a day and compression stockings for 6 weeks and lower extremity pneumatic compression devices while hospitalized. Screening bilateral lower extremity ultrasonography was performed within 1 week (mean, 4 days) of the procedure to detect asymptomatic DVTs.
Of the 134 patients, two patients (two hips) with negative postoperative screening ultrasounds presented at 14 and 38 days postoperatively with clinical symptoms of DVT. Repeat ultrasound confirmed this diagnosis in both cases. There were no symptoms of PE. Screening venous ultrasonography did not identify any DVTs during the early postoperative period before discharge. These two patients were treated with 3 to 6 months of warfarin anticoagulation. Neither patient had persistent symptoms related to the DVT.
These data indicate that the risk of symptomatic DVT associated with periacetabular osteotomy is low (1%) with use of aspirin and mechanical compression prophylaxis. Furthermore, routine postoperative screening did not detect any patients with an asymptomatic DVT.
Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
髋臼周围截骨术已成为治疗有症状髋臼发育不良的常用手术。与其他主要髋关节手术一样，人们担心其相关静脉血栓栓塞性疾病的风险。然而，关于筛查必要性的信息有限，且尚未确定最佳预防措施。
问题/目的：我们试图确定在接受阿司匹林和机械压迫预防治疗的患者中，髋臼周围截骨术相关血栓栓塞事件（深静脉血栓形成[DVT]和有症状肺栓塞[PE]）的发生率。
我们对8年间接受髋臼周围截骨术治疗的134例成年患者（149髋）进行了回顾性研究。在此期间，136髋（91%）在髋臼周围截骨术后1周内接受了DVT筛查，而13髋（9%）因各种原因未能接受评估。手术时患者的平均年龄为30岁（范围18 - 60岁），术后4至6个月内无患者失访。所有患者均采用相同的血栓栓塞预防方案。该方案包括每天两次服用325毫克阿司匹林，穿压迫袜6周，并在住院期间使用下肢气动压迫装置。在手术1周内（平均4天）进行双侧下肢超声检查以检测无症状DVT。
134例患者中，两名术后筛查超声阴性的患者分别在术后14天和38天出现DVT临床症状。复查超声在两例中均证实了该诊断。无PE症状。出院前术后早期的筛查静脉超声未发现任何DVT。这两名患者接受了3至6个月的华法林抗凝治疗。两名患者均无与DVT相关的持续症状。
这些数据表明，使用阿司匹林和机械压迫预防时，髋臼周围截骨术相关有症状DVT的风险较低（1%）。此外，常规术后筛查未发现任何无症状DVT患者。
IV级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
