Gelder Chloé, McCallum Audrey L, Macfarlane Alan J R, Anderson John H
Department of Surgery, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
Department of Surgery, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
Surgeon. 2018 Dec;16(6):365-371. doi: 10.1016/j.surge.2018.03.005. Epub 2018 Apr 23.
Venous thrombosis and compartment syndrome are potentially serious complications of prolonged, lithotomy position surgery. It is unclear whether mechanical thromboprophylaxis in this group of patients modifies the risk of compartment syndrome. This qualitative systematic review examines the evidence base to guide clinical practice.
A systematic review was performed guided by Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria, to identify studies reporting relationships between lithotomy position, compartment syndrome and mechanical thromboprophylaxis. The aim was to determine if mechanical thromboprophylaxis influenced compartment syndrome risk in the lithotomy position.
Sixteen studies were identified: eight case reports or case series (12 patients), two completed audit cycles (approximately 2000 patients), four reviews and two volunteer case control studies (33 subjects). There were no randomised studies. Nine studies associated mechanical thromboprophylaxis with compartment syndrome risk but in each case a causative relationship was speculative. In contrast, five papers, including an experimental, cohort study and two observational, population studies recommended intermittent pneumatic compression as prevention against compartment syndrome in lithotomy position. One review and one case report were unable to make a recommendation.
The level of evidence addressing the interaction between the lithotomy position, compartment syndrome and mechanical thromboprophylaxis is weak. There is no conclusive evidence that mechanical thromboprophylaxis causes compartment syndrome in the lithotomy position. There is limited evidence to suggest intermittent pneumatic compression may be a safe method of mechanical thromboprophylaxis if accompanied by strict adherence to other measures to reduce the chance of compartment syndrome. However further studies are required.
静脉血栓形成和骨筋膜室综合征是长时间截石位手术潜在的严重并发症。目前尚不清楚对这类患者进行机械性血栓预防是否会改变骨筋膜室综合征的风险。本定性系统评价旨在审查证据基础，以指导临床实践。
按照系统评价和Meta分析的首选报告项目（PRISMA）标准进行系统评价，以识别报告截石位、骨筋膜室综合征和机械性血栓预防之间关系的研究。目的是确定机械性血栓预防是否会影响截石位患者发生骨筋膜室综合征的风险。
共识别出16项研究：8篇病例报告或病例系列（12例患者）、2个完整的审计周期（约2000例患者）、4篇综述和2篇志愿者病例对照研究（33名受试者）。没有随机对照研究。9项研究将机械性血栓预防与骨筋膜室综合征风险相关联，但在每种情况下，因果关系都是推测性的。相比之下，5篇论文，包括1项实验性队列研究和2项观察性人群研究，推荐间歇性气动压迫作为预防截石位骨筋膜室综合征的方法。1篇综述和1篇病例报告无法给出推荐意见。
关于截石位、骨筋膜室综合征和机械性血栓预防之间相互作用的证据水平较低。没有确凿证据表明机械性血栓预防会导致截石位患者发生骨筋膜室综合征。有有限的证据表明，如果严格遵守其他降低骨筋膜室综合征发生几率的措施，间歇性气动压迫可能是一种安全的机械性血栓预防方法。然而，仍需要进一步的研究。
