Wirral University Teaching Hospital, Upton, UK.
Gold Coast University Hospital, Southport, Australia.
Bone Joint J. 2019 Jun;101-B(6):691-694. doi: 10.1302/0301-620X.101B6.BJJ-2018-1356.R1.
To our knowledge, there is currently no information available about the rate of venous thromboembolism (VTE) or recommendations regarding chemoprophylaxis for patients whose lower limb is immobilized in a plaster cast. We report a retrospective case series assessing the rate of symptomatic VTE in patients treated with a lower limb cast. Given the complex, heterogeneous nature of this group of patients, with many risk factors for VTE, we hypothesized that the rate of VTE would be higher than in the general population.
Patients treated with a lower limb cast between 2006 and 2018 were identified using plaster room records. Their electronic records and radiological reports were reviewed for details about their cast, past medical history, and any VTE recorded in our hospital within a year of casting.
There were 136 episodes of casting in 100 patients. The mean age was 55 years (22 to 91). The mean time in a cast was 45 days (five days to eight months). A total of 76 patients had neuropathy secondary to diabetes. No patient received chemical thromboprophylaxis while in a cast. One VTE (0.7% of casting episodes) was documented. This was confirmed by Doppler scan nine days after removing the cast.
The frequency of VTE was higher than that of the general population (0.05%); this is most likely attributable to our patients' apparent increase in VTE risk as suggested by The National Institute for Health and Care Excellence (NICE). These findings suggest that thromboprophylaxis is not routinely indicated in patients who undergo immobilization of the lower limb in a cast, although the risks of VTE should be assessed. While the cast itself does not pose an increased risk, other pathologies, such as active cancer, mean that each individual case needs to be considered on their merit. Cite this article: 2019;101-B:691-694.
据我们所知，目前尚无关于下肢石膏固定患者静脉血栓栓塞症（VTE）发生率或化学预防建议的信息。我们报告了一项回顾性病例系列研究，评估了下肢石膏固定患者中症状性 VTE 的发生率。鉴于这群患者具有多种 VTE 风险因素，其病情复杂且存在异质性，我们假设 VTE 的发生率会高于普通人群。
使用石膏房记录确定了 2006 年至 2018 年期间接受下肢石膏固定治疗的患者。查阅他们的电子病历和放射学报告，以了解有关其石膏、既往病史以及在石膏固定后一年内我院记录的任何 VTE 的详细信息。
100 名患者中共有 136 例石膏固定。平均年龄为 55 岁（22 岁至 91 岁）。平均石膏固定时间为 45 天（5 天至 8 个月）。共有 76 例患者因糖尿病导致周围神经病变。在石膏固定期间，没有患者接受化学预防血栓形成。1 例 VTE（占石膏固定发生率的 0.7%）被记录。在拆除石膏 9 天后，经多普勒扫描证实了这一点。
VTE 的频率高于普通人群（0.05%）；这很可能归因于我们的患者 VTE 风险增加，正如英国国家卫生与保健优化研究所（NICE）所建议的那样。这些发现表明，下肢石膏固定的患者通常不需要常规进行预防血栓形成，尽管应评估 VTE 的风险。虽然石膏本身不会增加风险，但其他病理情况，如活动性癌症，则意味着需要根据具体情况进行评估。引用本文：2019；101-B：691-694。
