脊柱转移瘤术后下肢深静脉血栓危险因素及预防

Risk factors and prevention of lower extremity deep venous thrombosis after spinal metastasis

目的探讨脊柱转移瘤术后下肢深静脉血栓(deep venous thrombosis,DVT)的危险因素及预防措施。方法本研究对象为2017年12月~2020年12月沧州中西医结合医院188例脊柱转移瘤患者,所有患者均采用手术治疗,将术后发生下肢DVT的患者设为DVT组,其余设为正常组。比较两组患者手术方式、病灶数量等病历资料,通过单因素分析、多因素分析调查脊柱转移瘤术后下肢DVT的危险因素。结果188例脊柱转移瘤术后发生DVT 30例;DVT组与正常组手术方式、合并脊髓和神经损伤、术后卧床时间、病灶数量、年龄、合并病理学骨折、手术时间、术中出血量差异有统计学意义(P<0.05),两组性别、体质量指数差异无统计学意义(P>0.05);Logistic回归分析显示,全椎体切除、合并脊髓和神经损伤、术后卧床时间>5 d、多发病灶是脊柱转移瘤术后DVT的危险因素。结论脊柱转移瘤术后容易发生下肢DVT,危险因素包括全椎体切除、合并脊髓和神经损伤等,应根据相关危险因素开展合理有效的预防措施,以降低术后下肢DVT的发生风险。

Objective To investigate the risk factors and preventive measures of lower extremity deep venous thrombosis(DVT)after spinal metastasis.Methods A total of 188 patients with spinal metastases in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from December 2017 to December 2020 were the subjects of this study.All patients were treated with surgery.Patients with postoperative lower extremity DVT were set as DVT group,and the rest were set as normal group.The operation Methods and the number of lesions were compared between the two groups.Risk factors for lower extremity DVT after spinal metastasectomy were investigated by univariate and multivariate analysis.Results Thirty DVTs occurred after surgery in 188 spinal metastases.There were significant differences in the surgical approach,combined spinal cord,nerve injury,postoperative bed rest time,number of lesions,age,combined pathological fracture,operative time,and intraoperative hemorrhage between the DVT and normal groups(P<0.05).There was no significant difference in gender or body mass index(BMI)between the two groups(P>0.05).Logistic regression analysis showed that total corpectomy,combined spinal cord,nerve injury,bed rest time>5 d after surgery,and multiple lesions were risk factors for DVT after surgery for spinal metastases.Conclusion Spinal metastases are prone to postoperative lower extremity DVT,and the risk factors include total corpectomy,complicated spinal cord,nerve injury,and so on.Reasonable and effective preventive measures should be developed according to the relevant risk factors so as to reduce the risk of postoperative lower extremity DVT.