脊柱侧凸患者术后血小板增多症的回顾性研究

Postoperative thrombocytosis in scoliosis patients:A retrospective study

背景:目前关于脊柱侧凸患者术后发生血小板增多的情况以及预后的报道较少。目的:研究脊柱侧凸患者术后血小板水平高于600×109/L(中度及以上血小板增高)的发生率以及临床特点,为诊断和治疗提供依据。方法:回顾性分析2009年1月至2014年12月行脊柱侧凸矫形手术且术前血小板水平正常的患者资料,术后血小板水平高于600×10~9/L(中度及以上血小板增高)者纳入研究组,同时按照1∶3的比例随机选择年龄、性别匹配的术后血小板水平正常的脊柱侧凸患者作为对照组。收集两组患者的脊柱侧凸类型、手术相关情况、术后并发症等信息进行比较,并观察研究组内科会诊及治疗方案、血小板水平恢复趋势以及血栓情况。结果:2009年1月至2014年12月手术治疗术前血小板水平正常的脊柱侧凸患者2512例,其中22例术后出现中等及以上血小板增多,中度及以上血小板增多的比例约为0.88%(22/2512),重度及以上血小板增多的比例约为0.24%(6/2512)。研究组患者的术中出血量、术后血色素下降值均高于对照组(P<0.001,P=0.012),肺部感染和(或)胸腔积液、切口愈合不良和感染均高于对照组(P<0.001,P=0.037)。22例患者经内科会诊后均排除原发性血小板增多症,考虑为继发性血小板增多症,行相关检查未发现血栓栓塞事件。2例血小板极度血小板增多患者予以口服阿司匹林治疗。随访中所有患者血小板水平呈逐步恢复趋势,最终均恢复至正常水平。结论:脊柱侧凸患者术后出现中等及以上血小板增多的比例不高,主要为继发性血小板增多症,与手术创伤、贫血状态、感染等因素相关,未增加血栓事件风险,对症处理相关因素后一般可恢复正常。

Background： There are few reports on postoperative thrombocytosis and prognosis in patients with scoliosis.Objective： To investigate the incidence and clinical significance of postoperative thrombocytosis in scoliosis patients. Methods： Postoperative laboratory data of scoliosis surgery cases between January 2009 and December 2014 were retrospective reviewed. The screen criterion of thrombocytosis group was platelet count 600×10~9/L. The control group was randomly selected from age-and gender-matched scoliosis patients with normal postoperative platelet count according to the ratio of1∶3. Clinical information of the two groups, such as scoliosis type, surgical information and complications, was collected.Results： Moderate level and above thrombocytosis were detected in 22 patients from total 2512 surgery cases（with the incidence of 0.88%）. Extreme thrombocytosis（platelet count 1000 × 109/L） was noticed in 6 patients（0.24%, 6/2512）. The blood loss and hemoglobin decline level in thrombocytosis group were significantly higher than those in control group（P〈0.001, P=0.012）. The incidences of pulmonary infection, hydrothorax and incision healing problems in thrombocytosis group were also higher than those in control group（P〈0.001, P=0.037）. Primary thrombocytosis was excluded in all the 22 patients. No subsequent thromboembolism events occurred in any patients. Two patients with extremely high level of thrombocytosis were suggested to take aspirin, while other patients recovered uneventfully without requiring any antiplatelet treatment. The platelet count returned to the normal level during follow up. Conclusions： There is a low incidence of postoperative thrombocytosis at moderate level and above in scoliosis patients. Most of them are secondary thrombocythemia, which is related to operative wound, anemia and infection. It does not lead to obvious thromboembolism but with risk and shows self-limited by treating relative factors.