Iliadis Alexios D, Timms Anna, Fugazzotto Sharron, Edel Penina, Britten Simon, Wright Jonathan, Goodier David, Calder Peter
Limb Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom.
Limb Reconstruction Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Strategies Trauma Limb Reconstr. 2020 Sep-Dec;15(3):151-156. doi: 10.5005/jp-journals-10080-1505.
The use of intramedullary lengthening devices is becoming increasingly popular. There are limited data regarding the incidence of venous thromboembolism following intramedullary lengthening surgery and no reports or guidance for current practice on use of thromboprophylaxis. Following a case of post-operative deep vein thrombosis in our institution, we felt that it is important to assess best practice. We conducted a national survey to collect data that would describe current practice and help develop consensus for treatment.
We identified surgeons across the UK that perform adult intramedullary limb lengthening through the British Limb Reconstruction Society membership and a Precise Users database. Surgeons were contacted and asked to respond to an online survey. Responses to thromboprophylaxis regimes employed in their practice and cases of venous thromboembolism were collated.
24 out of 54 surgeons identified responded with a total of 454 cases of adult intramedullary lengthening (352 femoral and 102 tibial nails) performed over a five year period (January 2015-January 2020). Only one case of deep venous thrombosis (DVT) following femoral lengthening was reported. There is wide variability in practice both in terms of thromboprophylaxis risk assessment, choice of medications and duration of treatment. The vast majority of surgeons (85%) felt that there was insufficient evidence available to guide their practice.
Intramedullary lengthening is a surgical treatment growing in popularity. There are limited data available to guide decision-making regarding aspects of treatment such as thromboprophylaxis. This is reflected in the wide variation in practice reported in this study. There are both a need and a desire to gather data that will allow us to come to a consensus and to guide safe practice.
Venous thromboembolism is a potential complication of lower limb lengthening surgery. We report on national incidence and current practices of thromboprophylaxis to allow for informed decision-making and help develop consensus for best practice.
Iliadis AD, Timms A, Fugazzotto S, et al. Thromboprophylaxis in Intramedullary Limb Lengthening Surgery. Strategies Trauma Limb Reconstr 2020;15(3):151-156.
髓内延长装置的使用越来越普遍。关于髓内延长手术后静脉血栓栓塞的发生率数据有限，目前尚无关于血栓预防使用的报告或现行实践指南。在我们机构发生一例术后深静脉血栓形成病例后，我们认为评估最佳实践很重要。我们进行了一项全国性调查，以收集描述当前实践的数据，并有助于形成治疗共识。
我们通过英国肢体重建协会会员和一个Precise用户数据库确定了英国各地进行成人髓内肢体延长手术的外科医生。我们联系了这些外科医生，并要求他们回复一项在线调查。整理了他们在实践中采用的血栓预防方案以及静脉血栓栓塞病例的回复。
在确定的54名外科医生中，有24名做出了回复，共报告了454例成人髓内延长手术（352例股骨钉和102例胫骨钉），手术时间为五年（2015年1月至2020年1月）。仅报告了1例股骨延长术后深静脉血栓形成（DVT）病例。在血栓预防风险评估、药物选择和治疗持续时间方面，实践存在很大差异。绝大多数外科医生（85%）认为没有足够的证据来指导他们的实践。
髓内延长是一种越来越受欢迎的外科治疗方法。关于血栓预防等治疗方面的决策指导数据有限。本研究报告的实践差异很大就反映了这一点。既需要也渴望收集数据，以便我们达成共识并指导安全实践。
静脉血栓栓塞是下肢延长手术的一种潜在并发症。我们报告了全国血栓预防的发生率和现行实践，以便做出明智的决策，并有助于形成最佳实践的共识。
伊利亚迪斯AD、廷姆斯A、富加佐托S等。髓内肢体延长手术中的血栓预防。《创伤肢体重建策略》2020；15（3）：151 - 156。
