Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Wangfujing, Dongcheng District, Beijing, China.
Spine (Phila Pa 1976). 2021 Oct 1;46(19):E1042-E1048. doi: 10.1097/BRS.0000000000003963.
A retrospective analysis (2015-2019) of data collected from patients who underwent posterior lumbar spinal surgery.
This study aims to identify the incidence, perioperative hematological characteristics, potential prognostic indicators, and risk factors of deep venous thrombosis (DVT) in the lower limbs after posterior lumbar spinal surgery. Eliminating risk factors or taking measures against patients at risk may reduce the incidence of DVT.
Deep venous thromboses have been extensively studied in other reconstructive surgeries. Present literatures provide limited evidence for determining the prognostic and risk factors for this complication after spinal surgery.
Patients who underwent posterior lumbar spinal surgery with internal fixation in the Spine Surgery Center of Peking Union Medical College Hospital (PUMCH) were evaluated. The patient demographics, the number of operative segments, the hematological and biochemical parameters on baseline and postoperative day 1, and the presence of DVTs were obtained from all patients. The diagnosis of DVT was established by venous ultrasound when symptomatic. A multivariate logistic regression test was subsequently performed to determine the prognostic indicators and risk factors for DVT.
A total of 2053 patients who received lumbar spine procedures were qualified and included. Patients were followed up for 12 weeks. Early symptomatic DVT occurred in 58 individuals (2.39%; 95% confidence interval [CI], 0.4-0.7%). Advanced age, higher preoperative serum D-dimer level, and lower serum potassium level were recognized as independent risk factors for symptomatic DVT.
Multiple independent risk factors were identified for early symptomatic DVT after posterior lumbar spine surgery. Postoperative prophylactic anti-coagulation treatment might be warranted for patients with high D-dimer or low potassium levels before the procedure.Level of Evidence: 4.
对 2015 年至 2019 年间接受后路腰椎脊柱手术的患者数据进行回顾性分析。
本研究旨在确定后路腰椎脊柱手术后下肢深静脉血栓形成（DVT）的发生率、围手术期血液学特征、潜在预后指标和危险因素。消除危险因素或针对高危患者采取措施可能会降低 DVT 的发生率。
深静脉血栓已在其他重建手术中得到广泛研究。目前的文献为确定脊柱手术后该并发症的预后和危险因素提供的证据有限。
评估了北京协和医院脊柱外科中心接受后路腰椎脊柱内固定手术的患者。从所有患者中获取患者人口统计学资料、手术节段数、基线和术后第 1 天的血液学和生化参数以及 DVT 存在情况。当有症状时，通过静脉超声诊断 DVT。随后进行多变量逻辑回归检验，以确定 DVT 的预后指标和危险因素。
共有 2053 名接受腰椎手术的患者符合条件并被纳入研究。患者随访 12 周。58 例（2.39%；95%置信区间 [CI]，0.4-0.7%）发生早期有症状 DVT。高龄、术前血清 D-二聚体水平升高和血清钾水平降低被认为是有症状 DVT 的独立危险因素。
后路腰椎脊柱手术后早期发生有症状 DVT 的独立危险因素较多。对于术前 D-二聚体水平较高或钾水平较低的患者，术后预防性抗凝治疗可能是必要的。
4 级。
