无症状性静脉血栓栓塞症在孤立性下肢骨折后不进行血栓预防时并不常见：膝关节-踝关节骨折（KAF）队列研究。

Symptomatic venous thromboembolism uncommon without thromboprophylaxis after isolated lower-limb fracture: the knee-to-ankle fracture (KAF) cohort study.

机构信息

Departments of Medicine (R.S., W.H.G., L.K., and F.S.), Clinical Pathology (R.S.), and Surgery (H.J.K.), Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. E-mail address for R. Selby: rita.selby@su.

Department of Medicine, St. Joseph's Healthcare, 50 Charlton Avenue East, McMaster University, Hamilton, ON L8N 4A6, Canada.

出版信息

J Bone Joint Surg Am. 2014 May 21;96(10):e83. doi: 10.2106/JBJS.M.00236.

DOI:10.2106/JBJS.M.00236

PMID:24875035

Abstract

BACKGROUND

The prevalence of deep vein thrombosis as demonstrated by routine venography in patients with distal lower-extremity injury requiring cast immobilization or surgery is 10% to 40%. These deep vein thromboses are usually asymptomatic and distal, and the need for thromboprophylaxis in these patients is not known.

METHODS

We conducted a multicenter prospective cohort study to define the prevalence of symptomatic venous thromboembolism in patients with a tibial, fibular, or ankle fracture (treated nonoperatively) or a patellar or foot fracture (treated operatively or conservatively). Consecutive patients were enrolled at five Ontario, Canada, hospitals within ninety-six hours after injury, and they were followed with a telephone interview at two, six, and twelve weeks. Thromboprophylaxis was not allowed. Suspected venous thromboembolism was investigated in a standardized manner.

RESULTS

From August 2002 to June 2005, 1200 patients were enrolled, and a three-month follow-up was completed for 98% of them. Eighty-two percent of the patients were treated with cast or splint immobilization for an average (and standard deviation) of 42 ± 32 days. Overall, seven patients (0.6%; 95% confidence interval [CI] = 0.2% to 1.2%) had symptomatic, objectively confirmed venous thromboembolism. Two of them had proximal deep vein thrombosis; three, calf deep vein thrombosis; and two, pulmonary embolism. There were no fatal pulmonary emboli.

CONCLUSIONS

Symptomatic venous thromboembolism is an infrequent complication after fractures of the distal part of the lower limb requiring cast immobilization and managed without thromboprophylaxis. Given these estimates of symptomatic venous thromboembolism, the risk-benefit ratio and cost-effectiveness of routine anticoagulant prophylaxis are unlikely to be favorable for these patients.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

在需要用石膏固定或手术治疗的下肢远端损伤的患者中，常规静脉造影显示深静脉血栓形成的患病率为 10%至 40%。这些深静脉血栓通常是无症状的，且位于远端，目前尚不清楚这些患者是否需要进行血栓预防。

方法

我们进行了一项多中心前瞻性队列研究，以确定胫骨、腓骨或踝关节骨折（非手术治疗）或髌骨或足部骨折（手术或保守治疗）患者中症状性静脉血栓栓塞的患病率。在受伤后 96 小时内，连续患者在加拿大安大略省的五家医院被纳入研究，并在 2、6 和 12 周时通过电话进行随访。不允许进行血栓预防。以标准化的方式对疑似静脉血栓栓塞进行调查。

结果

从 2002 年 8 月至 2005 年 6 月，共纳入 1200 例患者，其中 98%完成了三个月的随访。82%的患者接受石膏或夹板固定治疗，平均（标准差）为 42 ± 32 天。总体而言，有 7 例患者（0.6%；95%置信区间 [CI] = 0.2%至 1.2%）出现有症状的、经客观证实的静脉血栓栓塞。其中 2 例为近端深静脉血栓形成，3 例为小腿深静脉血栓形成，2 例为肺栓塞。无致命性肺栓塞发生。