Trauma and Orthopaedic Department, North Bristol NHS Trust, Westbury-On-Trym, Bristol, BS10 5NB, UK.
Trauma and Orthopaedic Department, Cairo University, Cairo, Egypt.
Eur J Orthop Surg Traumatol. 2021 Apr;31(3):491-495. doi: 10.1007/s00590-020-02795-z. Epub 2020 Sep 21.
Prevention and detection of thromboembolism with pelvic and acetabular fractures remains controversial. The aim of this study was to evaluate a protocol using LMWH prophylaxis and duplex screening both pre-operatively (if there is a delay > 72 h to surgery) and post-operatively at day 5-7. We assessed the incidence of thromboembolism and associated risk factors.
A total of 255 consecutive patients who underwent pelvic and/or acetabular reconstruction in a major trauma and tertiary referral centre between January 2013 and December 2015 were studied. Forty-three patients were excluded due to non-adherence to protocol leaving 212 patients included in the study.
Patients were of mean age 49 years (15-94) and mean ISS 24.5 (4-66). Pre-operative screening detected two patients with asymptomatic above-knee DVT who then underwent pre-operative IVC filter insertion. Post-operative screening detected seven patients (3%) with lower limb DVTs (3 proximal and 4 below knee). The three patients with proximal DVTs were fully anticoagulated and did not develop symptomatic PE. Six patients (2.8%) developed post-operative PE, four of which were symptomatic and confirmed by CT angiography. Seven patients (3%) died in the post-operative period due to non-VTE-related causes. The overall rate of VTE was 6%, including DVT 4% and PE 2.8%. PE was associated with administration of tranexamic acid in ED (p > 0.03) and total amount of blood transfused during admission (p > 0.001). VTE was not associated with age, injury type, ISS, delay to surgery or associated injuries.
A protocol-based approach to VTE prophylaxis and screening in trauma patients with pelvic and/or acetabular reconstruction resulted in no VTE-related mortality. Pre- and post-operative screening for DVT changed the management in five patients, with none developing PE. Patients requiring more aggressive resuscitation had a higher rate of PE. The VTE rate was lower than previously reported.
对于骨盆和髋臼骨折患者，预防和检测血栓栓塞仍然存在争议。本研究旨在评估一种方案，即在手术前（如果手术延迟超过 72 小时）和手术后第 5-7 天使用低分子肝素预防和进行双能超声筛查。我们评估了血栓栓塞的发生率及其相关危险因素。
2013 年 1 月至 2015 年 12 月，在一家主要创伤和三级转诊中心，对 255 例连续接受骨盆和/或髋臼重建的患者进行了研究。由于未遵循方案，有 43 例患者被排除在外，因此共有 212 例患者纳入研究。
患者平均年龄 49 岁（15-94 岁），ISS 平均为 24.5（4-66）。术前筛查发现 2 例无症状的大腿上段 DVT 患者，随后行术前下腔静脉滤器置入术。术后筛查发现 7 例（3%）下肢 DVT（3 例近端，4 例膝下）。3 例近端 DVT 患者充分抗凝，未发生症状性 PE。6 例（2.8%）患者发生术后 PE，其中 4 例经 CT 血管造影证实。7 例（3%）患者术后因非 VTE 相关原因死亡。总的 VTE 发生率为 6%，包括 DVT 4%和 PE 2.8%。PE 与 ED 中使用氨甲环酸（p>0.03）和住院期间总输血量（p>0.001）相关。VTE 与年龄、损伤类型、ISS、手术延迟或合并损伤无关。
对于接受骨盆和/或髋臼重建的创伤患者，基于方案的 VTE 预防和筛查方法未导致与 VTE 相关的死亡。术前和术后的 DVT 筛查改变了 5 例患者的治疗方案，且均未发生 PE。需要更积极复苏的患者 PE 发生率更高。该 VTE 发生率低于既往报道。
