目的 探讨脊柱术后孤立性小腿深静脉血栓形成的相关影响因素,为早期防治提供理论依据。方法 研究2017年6月—2019年6月脊柱疾病住院手术患者的病例特点,检索其一般情况,既往史,诊断编码,手术情况等。结果 经单因素分析及二元logistic回归分析结果表明,年龄、糖尿病史、体质量指数（BMI）、卧床时间、手术方式、术后脱水药应用情况及围手术期输血等是术后孤立性小腿深静脉血栓形成的危险因素、抗凝治疗是保护性因素。结论 脊柱术后孤立性小腿深静脉血栓形成有导致肺栓塞的风险,术前控制血糖,术后早期活动,对于血栓高风险患者,酌情使用抗凝药,可降低脊柱术后孤立性小腿深静脉血栓的发生率。
Objective To investigate influencing factors for isolated calf deep vein thrombosis （ICDVT） after spine operation, in order to provide a theoretical basis for early prevention and treatment of ICDVT cases. Methods Inpatients with spinal diseases from June 2017 to June 2019 were selected and analyzed. Their general information, disease history, diagnosis code, and operation information were collected. Results The results of single-factor analysis and binary logistic regression analysis showed that age, diabetes mellitus history, body mass index（BMI）, bedridden time, operative method, the use of dehydrants, and periopeartive blood transfusion were the risk factors of ICDVT, while anticoagulation was a protective factor. Conclusion ICDVT after spine surgery may increase the risk of pulmonary embolism, Preoperative blood glucose control and early mobilization, patients with a high risk of venous thrombosis may receive anticoagulant therapy to reduce the incidence rates of ICDVT.
[1] Franco L, Giustozzi M, Agnelli G, et al.Anticoagulation in patients with isolated distal deep vein thrombosis: A meta-analysis[J]. J Thromb Haemost, 2017,15(6):1142-1154.
[2] Piper K, Algattas H, DeAndrea-Lazarus IA, et al. Risk factors associated with venous thromboembolism in patients undergoing spine surgery[J]. J Neurosurg Spine, 2017,26(1):90-96.
[3] Starr AJ, Shirley Z, Sutphin PD, et al.Significant reduction of pulmonary embolism in orthopaedic trauma patients[J]. J Orthop Trauma, 2019,33(2):78-81.
[4] Shiu B, Le E, Jazini E, et al.Postoperative deep vein thrombosis, pulmonary embolism, and myocardial infarction: complications after therapeutic anticoagulation in the patient with spine trauma[J]. Spine (Phila Pa 1976), 2018,43(13):E766-E772.
[5] 颜征,张玥,李华文.孤立性小腿深静脉血栓形成诊治研究进展[J].中国中西医结合外科杂志,2016,22(2):191-193.
[6] 公茂峰,顾建平,陈国平,等.急性远端孤立型深静脉血栓形成患者治疗方法初探[J].中华放射学杂志,2018,52(8):636-639.
[7] 俞斌. 下肢深静脉血栓的诊断及治疗进展[J].中国骨与关节损伤杂志,2017,32(1):109-111.
[8] 李晓强,张福先,王深明.深静脉血栓形成的诊断和治疗指南(第3版)[J].中华普通外科杂志,2017,32(9):807-812.
[9] 李井云. 彩色多普勒超声诊断骨科术后下肢深静脉血栓形成的临床意义[J].临床研究,2017,25(7):185-186.
[10] 陈伟,江华. 2016年中国超重/肥胖医学营养治疗专家共识解读[J].中国实用内科杂志, 2017,37(5):430-433.
[11] 何田静,张岚,张庆军,等.湖北省成年居民吸烟与戒烟行为现状调查[J].中国公共卫生, 2018,34(5):652-655.
[12] 杨月欣,张环美.《中国居民膳食指南(2016)》简介[J].营养学报,2016,38(3):209-217.
[13] 向熙,司群超,成伟益,等.不同手术方式治疗腰椎间盘突出症的网状Meta分析[J].中国组织工程研究,2020,24(27):4398-4405.
[14] 许汝福. Logistic回归变量筛选及回归方法选择实例分析[J].中国循证医学杂志,2016,16(11):1360-1364.
[15] 周云灿,余可谊,张恒岩.脊柱外科手术后预防静脉血栓栓塞症的共识与争议[J].中华骨与关节外科杂志,2019,12(2):145-149.
[16] 徐福昌,石彩连,朱庆三,等.脊柱疾病术后静脉血栓栓塞症的危险因素研究进展[J]. 脊柱外科杂志,2019,17(1):70-73.
[17] Winther CF, Thomsen K, Sørensen LP, et al.Venous thromboembolic complications following surgical treatment for degenerative spinal disease[J]. Dan Med J, 2019,66(5):A5541.
[18] 潘磊. 年龄和BMI与关节置换术后下肢深静脉血栓形成的关系[J].包头医学院学报,2017,33(7):77-78.
[19] Tanaka T, Burton M, Woldu HG, et al.2016 Research Grant: The severity of preoperative A1c and predicting postoperative complications in spine surgery[J]. The Spine J, 2019,19(9):S147.
[20] Nazareth A, D'Oro A, Liu JC, et al. Risk factors for postoperative venous thromboembolic events in patients undergoing lumbar spine surgery[J]. Global Spine J, 2019,9(4):409-416.
[21] 李永军,唐小穗,孙广才,等.腰椎后路手术后并发深静脉血栓形成的相关因素分析[J].河北医药,2018,40(13):1993-1996.
[22] Kepler CK, McKenzie J, Kreitz T, et al. Venous thromboembolism prophylaxis in spine surgery[J]. J Am Acad Orthop Surg, 2018,26(14):489-500.
[23] 付斌,丁惠强.脊柱手术后预防下肢深静脉血栓抗凝时间窗研究及对凝血因子的影响[J].颈腰痛杂志,2019,40(5):698-699.
[24] Ekamjeet S Dhillon, Ryan Khanna, Michael Cloney, et al.Timing and risks of chemoprophylaxis after spinal surgery: A single-center experience with 6869 consecutive patients[J]. J Neurosurg Spine, 2017,27(6):1-13.
[25] Valentijn TM, Hoeks SE, Bakker EJ, et al.The impact of perioperative red blood cell transfusions on postoperative outcomes in vascular surgery patients[J]. Ann Vasc Surg, 2015, 29(3):511-519.
[26] 李毅嵩,王庆敏,吴志君,等.微创及传统开放手术治疗腰椎退行性疾病临床比较[J]. 外科研究与新技术, 2017,6(4):253-255.
[27] 曾金美,周琳,宋浩明.静脉血栓栓塞症的免疫功能变化[J].外科研究与新技术, 2014,3(4):279-282.
