Wang Tao, Yang Si-Dong, Huang Wen-Zheng, Liu Feng-Yu, Wang Hui, Ding Wen-Yuan
Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang Jizhong Energy Fengfeng Group General Hospital, Handan Shi, Hebei Province Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China.
Medicine (Baltimore). 2016 Dec;95(52):e5776. doi: 10.1097/MD.0000000000005776.
A meta-analysis was performed to explore predicted factors of venous thromboembolism (VTE) after surgery in the treatment for spine degeneration diseases.
Many scholars have focused on VTE after spine surgery, but as for the risk factors of VTE have not reached a consensus.
An extensive search of literature, "spine or spinal," "degeneration," "after surgery or postoperation," and "venous thromboembolism" as key words, was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases. The following variables were extracted: wearing elastic stocking, hypertension (HT), heart disease, diabetes, drinking, anticoagulant therapy, walking disability preoperation, smoking, sex, age, surgical duration, fusion versus nonfusion (lumbar fusion vs lumbar discectomy), surgical site (cervical vs lumbar), blood loss, and body mass index. Data analysis was conducted with RevMan 5.3 and STATA 12.0.
A total of 12 studies were identified, including 34,597 patients of whom 624 patients had VTE, and the incidence of VTE was 2% in all patients who underwent spine surgery. The incidence of VTE for Asian patients was 7.5%, compared with 1% VTE for Occidental patients; the difference was significant (P < 0.0001). The pooled analysis showed that there were significant differences regarding wearing elastic stocking (odds ratio [OR] = 11.71, 95% confidence interval [CI] [1.46, 94.00], P = 0.02), walking disability preoperation (OR = 4.80, 95% CI [2.53, 9.12], P < 0.00001), surgical site (lumbar surgery) (OR = 0.23, 95% CI [0.20, 0.27], P < 0.00001), HT (OR = 1.59, 95% CI [1.21, 2.10], P = 0.001), and diabetes (OR = 2.12, 95% CI [1.09, 4.10], P = 0.03). However, there were no significant differences in blood loss, heart disease, smoking, sex, surgical duration, body mass index, surgical duration, anticoagulant therapy, wearing elastic stocking, fusion versus nonfusion, drinking, and age (all P > 0.05).
Based on our meta-analysis, Asian patients, patients with walking disability preoperation, patients wearing elastic stocking, patients having undergone lumbar surgery, patients with a history of HT, and patients experiencing diabetes have a higher incidence of VTE after spine surgery.
进行一项荟萃分析以探究脊柱退行性疾病手术治疗后静脉血栓栓塞症（VTE）的预测因素。
许多学者关注脊柱手术后的VTE，但关于VTE的危险因素尚未达成共识。
在PubMed/MEDLINE、Embase、Cochrane图书馆、中国知网和万方数据库中，以“脊柱或脊椎”“退变”“手术后或术后”以及“静脉血栓栓塞症”作为关键词进行广泛的文献检索。提取以下变量：穿弹力袜、高血压（HT）、心脏病、糖尿病、饮酒、抗凝治疗、术前行走障碍、吸烟、性别、年龄、手术时长、融合与非融合（腰椎融合术与腰椎间盘切除术）、手术部位（颈椎与腰椎）、失血量和体重指数。使用RevMan 5.3和STATA 12.0进行数据分析。
共纳入12项研究，包括34597例患者，其中624例发生VTE，脊柱手术患者中VTE的发生率为2%。亚洲患者VTE的发生率为7.5%，而西方患者为1%；差异有统计学意义（P<0.0001）。汇总分析显示，在穿弹力袜（比值比[OR]=11.71，95%置信区间[CI][1.46, 94.00]，P=0.02）、术前行走障碍（OR=4.80, 95% CI[2.53, 9.12]，P<0.00001）、手术部位（腰椎手术）（OR=0.23, 95% CI[0.20, 0.27]，P<0.00001）、HT（OR=1.59, 95% CI[1.21, 2.10]，P=0.001）和糖尿病（OR=2.12, 95% CI[1.09, 4.10]，P=0.03）方面存在显著差异。然而，在失血量、心脏病、吸烟、性别、手术时长、体重指数、手术时长、抗凝治疗、穿弹力袜、融合与非融合、饮酒和年龄方面无显著差异（所有P>0.05）。
基于我们的荟萃分析，亚洲患者、术前有行走障碍的患者、穿弹力袜的患者、接受腰椎手术的患者、有HT病史的患者以及患有糖尿病的患者脊柱手术后VTE的发生率较高。
