创伤患者因脑血管损伤正在接受抗凝治疗时的颈椎减压融合术结果：一项回顾性比较研究
Cervical Spine Decompression and Fusion Outcomes in Trauma Patients Actively Receiving Anticoagulation Treatment for Cerebrovascular Injury: A Retrospective Comparative Study.
作者信息
Camillo Francis X, Mitchell Sean M
机构信息
Spine Specialty Center, Memphis, Tennessee.
University of Arizona, Phoenix, Arizona.
出版信息
Int J Spine Surg. 2020 Feb 29;14(1):66-71. doi: 10.14444/7009. eCollection 2020 Feb.
BACKGROUND
Cervical spine blunt trauma patients with the presence of a cerebrovascular injury may be given initiation of heparin anticoagulation treatment prior to necessary surgical stabilization. Literature regarding the safety and efficacy of these procedures while a patient is on active anticoagulation is limited, requiring further investigation. The primary research question for this study is: Can cervical spine decompression and fusion in the context of a blunt cerebrovascular injury and anticoagulation therapy be completed safely? To accomplish this a comparison of outcomes and perioperative complications was made to a control group.
METHODS
A total of 63 trauma patients requiring cervical spine decompression and fusion from 2013 to 2015 were identified at our North American level 1 trauma center. Evaluation of patient injury data, bleeding events, postoperative infections, and neurologic outcomes was collected from chart review. The American Spinal Injury Association (ASIA) grading system was used to measure change in postoperative neurologic outcomes.
RESULTS
Of 63 patients, 14 had a concomitant cerebrovascular injury that required perioperative anticoagulation treatment. In the 14 patients receiving anticoagulation, 11 had anterior and 3 had posterior stabilization. A total of 2 patients experienced a complication (pneumonia and hardware failure), but neither was related to anticoagulation. An elevated prothrombin time value was noted postoperatively in 1 patient, but with no adverse outcome. No bleeding or thrombotic events, surgical site infection, or neurologic deterioration occurred. The difference in postoperative ASIA grades between groups was not significantly different ( = .57).
CONCLUSIONS
The operative cohort receiving anticoagulation therapy did not demonstrate an increase affinity for perioperative complications or a decline in ASIA scores postoperatively when compared to a control cohort.
CLINICAL RELEVANCE
Patients with a cerebrovascular injury receiving anticoagulation treatment can undergo safe and successful cervical spine stabilization procedures.
LEVEL OF EVIDENCE
Therapeutic level III.
背景
存在脑血管损伤的颈椎钝性创伤患者，在进行必要的手术稳定治疗之前，可能会开始肝素抗凝治疗。关于患者在接受积极抗凝治疗期间这些操作的安全性和有效性的文献有限，需要进一步研究。本研究的主要研究问题是：在钝性脑血管损伤和抗凝治疗的情况下，颈椎减压融合术能否安全完成？为实现这一目标，将结果和围手术期并发症与对照组进行了比较。
方法
在我们的北美一级创伤中心，确定了2013年至2015年期间共63例需要颈椎减压融合术的创伤患者。通过病历审查收集患者损伤数据、出血事件、术后感染和神经学结果的评估。采用美国脊髓损伤协会（ASIA）分级系统来衡量术后神经学结果的变化。
结果
63例患者中，14例伴有脑血管损伤，需要围手术期抗凝治疗。在接受抗凝治疗的14例患者中，11例行前路稳定术，3例行后路稳定术。共有2例患者出现并发症（肺炎和内固定失败），但均与抗凝无关。1例患者术后凝血酶原时间值升高，但无不良后果。未发生出血或血栓形成事件、手术部位感染或神经功能恶化。两组术后ASIA分级差异无统计学意义（=0.57）。
结论
与对照组相比，接受抗凝治疗的手术队列在围手术期并发症方面没有表现出增加的倾向，术后ASIA评分也没有下降。
临床意义
接受抗凝治疗的脑血管损伤患者可以安全、成功地进行颈椎稳定手术。
证据水平
治疗性III级。
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