椎体骨折合并活化部分凝血活酶时间延长1例

Vertebral fractures combined with prolonged activated partial prothrombin time:A case report

随着骨质疏松症发病率的逐年上升,骨质疏松性椎体压缩性骨折的发病率也逐渐增高[1]。自身免疫病患者由于疾病本身特点以及长期使用糖皮质激素治疗,会影响患者的骨形成和骨吸收[2],继而出现严重的继发性骨质疏松症,因而发生骨质疏松性椎体骨折的风险更高[3]。

With the development of modern medical standards,autoimmune diseases and their associated successive osteoporosis have received increasing attention in recent years.Patients with autoimmune diseases,due to the characteristics of the disease and the prolonged use of glucocorticoid hormone therapy,may affect the bone formation and bone absorption of the patient,followed by severe successive osteoporosis,thereby increasing the risk of osteoporotic vertebral fractures.Vertebral compression fractures of the spine are common fracture types in patients with osteoporotic fractures.Osteoporosis is a common complication after glucocorticoid therapy in patients with autoimmune diseases.Percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP)are minimally invasive operation and are commonly used surgical methods for the treatment of osteoporotic vertebral compression fractures.However,due to the operation of spinal puncture during the operation,there are serious surgical risks such as bone cement leakage,spinal epidural hemorrhage,subdural hemorrhage,and subarachnoid hemorrhage in both PVP and PKP.As a result,it is necessary to evaluate the patient’s body before surgery carefully,especially in the case of blood coagulation.This article reports a case of autoimmune disease patient admitted to Peking University People’s Hospital due to lumbar 4 vertebral compression fracture combined with Sj gren’s syndrome.The patient’s preoperative examination showed that the activated partial thromboplastin time(APTT)was significantly prolonged.After completing the APTT extended screening experiment and lupus anticoagulant factor testing,the multi-disciplinary team(MDT)of Peking University People’s Hospital jointly discussed the conclusion that the patient’s test results were caused by an abnormal self-immunity anti-copulant lupus(LAC).Based on the results of the laboratory examination,the patient was considered to be diagnosed with combined antiphospholipid syndrome(APS).For such patients,compared with the patient’s tendency to bleed,we should pay more attention to the risk of high blood clotting in the lower limbs of the patient,pulmonary clots and so on.With timely anti-coagulation treatment,the patient safely passed the peripheral period and was successfully discharged from the hospital.Therefore,for patients with autoimmune diseases with prolonged APTT in the perioperative period,doctors need to carefully identify the actual cause and carry out targeted treatment in order to minimize the risk of surgical and perioperative complications and bring satisfactory treatment results to the patients.