读医学网

目的：计算脊柱减压融合术后的静脉血栓发生率。

背景资料概述：脊柱外科术后的静脉血栓栓塞症是一种严重的并发症，但药物预防并非没有重大风险，如硬膜外血肿。目前的文献存在以下不足：报道的静脉血栓发生率差异甚大、样本规模较小、诊断特异性以及研究方法上存在患者随访期不足的问题。

国家级住院病人，门诊手术，以及急诊科的管理数据库被用来随访发生临床重大VTE的患者，这些患者都在脊柱手术后90天内。

结果：参与的357926个患者中，1/3只做了脊柱减压术，但是2/3接受了脊柱融合术。VTE的总比率是1.37% (95% CI: 1.33–1.41)，但根据诊断相差很大，1.03% 的结构退行性诊断到10.7% 的脊柱感染。后路融合比前路融合有更高的VTE比率，但是前胸腰椎和腰骶融合分别比后路融合有更高比率。额外的风险包括病人在住院期间接受了长期的脊柱融合术和多种手术。40%被发现为VTE的患者是在不同的医院得到诊断。

结论：根据诊断和手术的不同，脊柱VTE的比率相差很大。为准备做脊柱手术的病人做危险分级来鉴别处于高风险的患者（这些患者应该监测VTE的发生）是很重要的。我们有必要知道几乎一半的患者在出院后发生VTE并在不同的医院得到诊断，因此主刀医生可能最先意识到这个并发症。根据诊断和手术过程，这些来自历史患者的大选择的结果可能提供一个评估患者风险的工具。

Venous Thromboembolism After Spine Surgery

Abstract

Study Design. Retrospective cohort study.

Objective. To measure the rate of postoperativevenous thromboembolic events (VTE) after spine decompression and fusionprocedures.

Summary of Background Data. VTE after spinesurgery is a serious complication, but chemoprophylaxis is not withoutsignificant risk due to the concern of epidural hematoma. Current literaturereport widely variable rates of VTE, and have weaknesses in sample size,specificity of diagnosis, and methodological problems with adequate patientfollow-up.

Methods. State-level inpatient, ambulatorysurgery, and emergency department administrative databases were used to trackpatients for clinically significant VTE within 90 days of discharge after aspine procedure.

Results. Of 357,926 patients enrolled,one-third underwent spine decompression alone, whereas two-thirds received aspine fusion. The overall rate of VTE was 1.37% (95% CI: 1.33–1.41), but variedwidely depending on diagnosis, 1.03% for structural degenerative diagnoses to10.7% for spine infection. Posterior cervical fusion had a higher rate of VTEthan anterior cervical fusion, whereas anterior thoracolumbar and lumbosacralfusions had higher rates than the respective posterior approaches. Additionalrisk factors included patients receiving long spine fusions and having multipleprocedures during the hospitalization. Forty percent of VTEs discovered afterdischarge were diagnosed at a different hospital.

Conclusion. The rate of spine VTE varieswidely depending on diagnosis and procedure. It is important to risk-stratifypatients who present for spine surgery to identify patients at increased riskwho should be monitored for the development of VTE. It is important to knowthat nearly half of VTEs that occur after discharge are diagnosed at differenthospitals, and thus the primary surgeon may be initially unaware of thecomplication. These results from a large selection of historical patients mayprovide a tool for estimating patient risk depending on diagnosis and type ofprocedure.