Niikura Takahiro, Sakai Yoshitada, Lee Sang Yang, Iwakura Takashi, Kuroda Ryosuke, Kurosaka Masahiro
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
J Orthop Surg (Hong Kong). 2015 Apr;23(1):37-40. doi: 10.1177/230949901502300109.
To evaluate the rate of venous thromboembolism (VTE) after complex lower-limb fracture surgery without pharmacological prophylaxis.
Between July 2005 and April 2009, 11 men and 6 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 3 femoral and 20 tibial fractures. Patients were screened for VTE using contrast-enhanced computed tomography (CT) when the D-dimer value was beyond normal range. Between May 2009 and December 2012, 18 men and 4 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 8 femoral and 20 tibial fractures. Patients were routinely screened for deep vein thrombosis (DVT) using ultrasonography and for pulmonary embolism (PE) using contrast-enhanced CT (in high-risk patients with multiple injuries or pelvic and acetabular fractures). In both groups, pharmacological prophylaxis was not used; only mechanical prophylaxis was used.
The 2 groups were comparable in terms of age, sex, and proportion of bilateral external fixation, open fracture, and associated injury, except that the duration of external fixation was longer in the early group (29.8±28.0 vs. 11.6±4.0 days, p=0.001). Of the 17 patients in the early group, 5 developed VTEs (3 DVTs and 2 PEs) at a mean of 13.6 (range, 6-20) days after injury; 2 of whom developed VTE during the external fixation period. Of the 22 patients in the later period, 10 developed VTEs (10 DVTs and 4 PEs) at a mean of 13 (range, 5-33) days after injury; 7 of whom developed VTE during the external fixation period.
The rate of VTE was high in patients undergoing complex lower-limb fracture surgery without pharmacological prophylaxis.
评估在未进行药物预防的情况下，复杂下肢骨折手术后静脉血栓栓塞症（VTE）的发生率。
2005年7月至2009年4月，11名男性和6名女性（平均年龄45岁）接受了临时外固定，随后进行内固定，共治疗3例股骨骨折和20例胫骨骨折。当D - 二聚体值超出正常范围时，使用对比增强计算机断层扫描（CT）对患者进行VTE筛查。2009年5月至2012年12月，18名男性和4名女性（平均年龄45岁）接受了临时外固定，随后进行内固定，共治疗8例股骨骨折和20例胫骨骨折。使用超声对患者进行深静脉血栓形成（DVT）常规筛查，使用对比增强CT对肺栓塞（PE）进行筛查（适用于有多处损伤或骨盆及髋臼骨折的高危患者）。两组均未使用药物预防；仅使用了机械预防措施。
两组在年龄、性别、双侧外固定比例、开放性骨折及合并伤方面具有可比性，但早期组的外固定时间更长（29.8±28.0天对11.6±4.0天，p = 0.001）。早期组的17例患者中，5例发生VTE（3例DVT和2例PE），平均在受伤后13.6天（范围6 - 20天）；其中2例在外部固定期间发生VTE。后期组的22例患者中，10例发生VTE（10例DVT和4例PE），平均在受伤后13天（范围5 - 33天）；其中7例在外部固定期间发生VTE。
在未进行药物预防的复杂下肢骨折手术患者中，VTE发生率较高。
