论文部分内容阅读
目的 探讨分级预防措施对腰椎后路椎间融合内固定术后预防早期深静脉血栓(deep venous thrombosis,DVT)的安全性及有效性.方法 回顾性分析2012年08月至2015年01月1 549例接受腰椎后路椎间融合内固定术患者的病历资料,术前经双下肢血管多普勒超声检查(color doppler flow imaging,CDFI)确认均无血栓形成,充分评估DVT的危险因素,并按评分结果分为低危组(139例,8.9％)、中危组(353例,22.8％)、高危组(805例,52.0％)及极高危组(252例,16.3％),接受分级预防.低危组采用基础预防措施;中危组主要采用物理预防措施;高危和极高危组采用基础+物理预防措施,并联合应用低分子肝素(low molecular weight heparin,LMWH).所有患者均于术后5～10 d行双下肢CDFI评估有无DVT形成,同时观察、记录硬膜外或切口血肿发生情况;对有或可疑有DVT形成者,术后3个月复查CDFI明确血栓变化情况.结果 1 057例(68.3％)患者同时具备3个及以上危险因子,其术后形成DVT具有高危或极高危风险,仅139例(8.9％)患者为低危人群.共27例发生DVT,发生率为1.74％;低危组0例,中危组3例(0.85％),高危组15例(1.86％),极高危组9例(3.57％).2例为腓静脉,1例为胫后静脉,余24例均为小腿肌间静脉,所有DVT发生部位均为下肢远端,且均无临床症状.所有患者均未发生肺栓塞.1 057例联合应用LMWH的患者均未发生硬膜外或切口血肿.术后3个月复查CDFI,1例腓静脉和11例小腿肌间静脉DVT患者出现血管再通,其余患者未见血栓进展.结论 针对腰椎后路椎间融合术后DVT形成的危险因素进行分级预防,能够安全、有效地预防早期DVT的发生;基础+物理预防措施联合应用LMWH抗凝治疗,术后未出现严重并发症,能明显降低DVT和PE的发生率.“,”Objective To investigate the safety and efficacy of the classification prevention of early deep venous thrombosis (DVT) after posterior/transforaminal lumbar interbody fusion (PLIF/FLIF).Methods From August 2012 to January 2015, 1 549 patients were separated after PLIF/TLIF procedure with DVT risk factors into low, medium, high and extremely high risk groups for 139, 353, 805 and 252 cases respectively.Basic prevention measures were used in the low risk group.Physical prevention measures such as thigh-length thromboembolic deterrent stockings (TEDS) and pneumatic sequential compression device (PSCD) were used in medium risk group.In high and extremely high risk groups, low molecular weight heparin (LMWH) was applied in addition to basic and physical prevention measures.Lower limb vascular doppler ultrasonography was used to monitor DVT pre-and postoperatively.The occurrences of epidural or wound hematoma were monitored.Results All of 1 057 patients (68.3％) suffered a high risk or extremely high risk of DVT, who have three or more risk factors.Only 139 patients (8.9％) were low risk population.Among the 1 549 cases of patients with PLIF/TLIF procedure, DVT occurred in 27 cases, and the incidence was 1.74％.There were 0, 3, 15 and 9 patients with positive findings of DVT on duplex uitrasonograph respectively in low, medium, high and extremely high risk groups.Two patients were experienced fibular veins thrombosis, and one with posterior tibial vein thrombosis.All of the remaining was thrombus in calf.However, all of them were asymptomatic.There was no case of pulmonary embolism (PE) or case with epidural or wound hematoma.No thrombus progressed was found in 3 months after operation.Among them, one case with fibular veins thrombosis and 11 cases with calf muscular veins thrombosis were recanalized.Conclusion According to the risk factors of DVT after PLIF/TILF, the classification prevention of early DVT is safe and effective.On the basis of basic and physical prevention measures, the combined use of LMWH has important significance to prevent DVT in patients with high and extremely high risk.