Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC, USA.
The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Research Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA.
Arch Orthop Trauma Surg. 2021 Mar;141(3):403-409. doi: 10.1007/s00402-020-03505-4. Epub 2020 Jun 5.
The rate of venous thromboembolism following surgical treatment of proximal humerus fractures is not well established.
A retrospective review of all patients undergoing surgical treatment for proximal humerus fractures from September 2011 to May 2017 was performed. Included patients received only mechanoprophylaxis using sequential compression devises. All patients had at least 6 months follow-up. The primary outcome of interest was the rate of postoperative DVT and PE.
131 patients underwent 139 surgeries for proximal humerus fracture. After exclusion criteria were applied, 92 patients who underwent 92 surgeries were included. There were 47 females and 45 males. Five (5.4%) were taking Aspirin 81 mg preoperatively. There were 76 cases of open reduction and internal fixation (ORIF), 8 cases of reverse total shoulder arthroplasty, 4 cases of hemiarthroplasty, 3 cases of closed reduction percutaneous pinning (CRPP), 1 case of open reduction without fixation. 53.3% of patients had one or more risk factors for VTE. There were no cases of fatal PE or DVT. There were two cases of symptomatic PE (2.2%) following one ORIF and one CRPP. There was one additional case of asymptomatic PE found incidentally after ORIF. Overall VTE rate was 3.3%. Fisher's exact test yielded that there was no significant association between the presence of VTE risk factors and prevalence of VTE postoperatively (p = 0.245).
The incidence of symptomatic VTE after surgery for proximal humerus fractures is low. Chemical VTE prophylaxis in patients after surgical fixation for proximal humerus fractures is not universally indicated. Selective prophylaxis for patients with systemic risk factors may be warranted.
手术治疗肱骨近端骨折后静脉血栓栓塞症的发生率尚不清楚。
对 2011 年 9 月至 2017 年 5 月期间接受肱骨近端骨折手术治疗的所有患者进行回顾性研究。纳入患者仅接受序贯加压装置的机械预防。所有患者均随访至少 6 个月。主要观察指标为术后深静脉血栓形成和肺栓塞的发生率。
131 例患者共进行 139 次肱骨近端骨折手术。排除标准应用后，纳入 92 例患者共 92 次手术。其中女性 47 例，男性 45 例。术前服用阿司匹林 81mg 者 5 例（5.4%）。切开复位内固定（ORIF）76 例，反式全肩关节置换 8 例，人工半肩关节置换 4 例，闭合复位经皮克氏针固定 3 例，切开复位未固定 1 例。有一个或多个静脉血栓栓塞症危险因素的患者占 53.3%。无致命性肺栓塞或深静脉血栓形成病例。ORIF 和 CRPP 后各有 1 例症状性肺栓塞，ORIF 后另发现 1 例无症状性肺栓塞。总静脉血栓栓塞症发生率为 3.3%。Fisher 确切概率法分析显示，静脉血栓栓塞症危险因素的存在与术后静脉血栓栓塞症的发生无显著相关性（p=0.245）。
肱骨近端骨折手术后症状性静脉血栓栓塞症的发生率较低。并非所有接受肱骨近端骨折手术内固定的患者均需要化学预防血栓形成。对于有系统性危险因素的患者，选择性预防可能是必要的。
