Si Wen-Teng, Zhang Hua-Guo, Sun Yi-Bao, Bai Yu
Zhongguo Gu Shang. 2014 May;27(5):405-8.
To analyze the relation of plasma D-dimer levels and incidence of deep venous thrombosis after spinal surgery.
The clinical data of 63 patients underwent spinal surgery from October 2009 to October 2010 were retrospective analyzed. There were 40 males and 23 females with an average age of 48 years old(21 to 76) in operation. Operation levels of 15 cases were in cervical vertebrae, 4 cases were in thoracic vertebrae,and 44 cases were in lumbar vertebrae. Thirty patients with spinal fracture were caused by trauma and 33 patients without trauma, 11 patients combined with nerve injury. The patients were divided into two groups according to plasma D-dimer levels, more than or equal to 500 microg/L was D-dimer positive group and less than 500 microg/L was D-dimer negative group. Venous blood of all patients early morning with empty stomach were testd on admission, and at 2 h, 1 d, 2 d, 3 d, 4 d, 6 d, 8 d, 10 d, 15 d after operation,respectively.
There was no statistically significant differences in sex, operative segments, implants, operative posture, age, bleed volume, body weight, peroperative D-dimer levels between two groups. After operation, plasma D-dimer of 19 patients were more than or equal to 500 microg/L, with persistent or progressive increasing. Two cases occurred deep venous thrombosis in D-dimer positive group, they respectively were found at 3 days and 8 days after operation. Both of them underwent posterior decompression and internal fixation. However,no deep venous thrombosis was found in D-dimer negative group.
Postoperative D-dimer assay can effective predict deep venous thrombosis occurrence. D-dimer level more than or equal to 500 microg/L will be considered as a risk factor for deep venous thrombosis after spinal surgery.
分析脊柱手术后血浆D - 二聚体水平与深静脉血栓形成发生率的关系。
回顾性分析2009年10月至2010年10月行脊柱手术的63例患者的临床资料。手术患者中男性40例,女性23例,平均年龄48岁(21至76岁)。手术节段:颈椎15例,胸椎4例,腰椎44例。脊柱骨折患者30例由外伤引起,33例无外伤,11例合并神经损伤。根据血浆D - 二聚体水平将患者分为两组,D - 二聚体≥500μg/L为D - 二聚体阳性组,<500μg/L为D - 二聚体阴性组。所有患者入院清晨空腹及术后2小时、1天、2天、3天、4天、6天、8天、10天、15天分别采集静脉血检测。
两组患者在性别、手术节段、植入物、手术体位、年龄、出血量、体重、术中D - 二聚体水平等方面差异无统计学意义。术后19例患者血浆D - 二聚体≥500μg/L,呈持续或进行性升高。D - 二聚体阳性组发生深静脉血栓2例,分别于术后3天和8天发现。均行后路减压内固定术。D - 二聚体阴性组未发现深静脉血栓。
术后检测D - 二聚体可有效预测深静脉血栓的发生。D - 二聚体水平≥500μg/L可作为脊柱手术后深静脉血栓形成的危险因素。