Lim Jeremy Wei Sern, Zhang Wei, Park Derek Howard, Premchand Antony Xavier Rex
Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore.
Trauma Case Rep. 2021 Sep 11;36:100534. doi: 10.1016/j.tcr.2021.100534. eCollection 2021 Dec.
Disseminated intravascular coagulation (DIC) is a rare condition that is known to affect patients with metastatic prostate adenocarcinoma. In an unsuspecting orthopaedic surgeon, DIC could lead to significant morbidity and mortality. This article highlights another such case and discusses management strategies to help improve clinical outcomes for these patients.
A 70-year-old male with metastatic prostate adenocarcinoma underwent prophylactic intramedullary nailing of an impending right femur pathological fracture. Surgery was uneventful, however postoperatively he was haemodynamically unstable with heavily soaked dressings. Laboratory investigations revealed DIC. Supportive treatment and correction of coagulopathy were undertaken. Ketoconazole was also initiated by Urology Services to treat the underlying condition of metastatic prostate carcinoma. Unfortunately, the patient responded poorly and passed away.
DIC is rarely encountered in orthopaedic surgery, but carries significant morbidity and mortality risks. Patients with risk factors, in particular metastatic cancer, should be screened for non-overt pre-DIC state and coagulopathies corrected preoperatively. Initiating treatment of underlying condition can be considered preoperatively in established non-overt DIC. Operative technique can also be modified to minimise risk of fat or tumour emboli. Early recognition, prompt resuscitation and timely treatment of underlying condition may be able to improve the outcomes in these patients.
弥散性血管内凝血（DIC）是一种罕见的病症，已知会影响转移性前列腺腺癌患者。对于毫无察觉的骨科医生而言，DIC可能导致严重的发病和死亡。本文重点介绍了另一例此类病例，并讨论了有助于改善这些患者临床结局的管理策略。
一名患有转移性前列腺腺癌的70岁男性因即将发生的右股骨病理性骨折接受了预防性髓内钉固定术。手术过程顺利，但术后他血流动力学不稳定，敷料大量渗血。实验室检查显示为DIC。进行了支持治疗和凝血病的纠正。泌尿外科还开始使用酮康唑治疗转移性前列腺癌的潜在病症。不幸的是，患者反应不佳，最终去世。
DIC在骨科手术中很少见，但具有重大的发病和死亡风险。对于有风险因素的患者，尤其是转移性癌症患者，应筛查非显性的DIC前期状态，并在术前纠正凝血病。对于已确诊的非显性DIC，可考虑在术前开始治疗潜在病症。手术技术也可进行改进，以尽量减少脂肪或肿瘤栓子的风险。早期识别、及时复苏和及时治疗潜在病症可能能够改善这些患者的结局。
