低分子肝素预防后路单节段腰椎固定融合术术后下肢血栓形成的回顾性研究

A Retrospective Study of Low Molecular Heparin for the Prevention of Postoperative Lower Extremity Thrombosis after Posterior Single-Segment Lumbar Fixation and Fusion Surgery

摘要: 目的：探讨在后路单节段腰椎固定融合术术后预防性应用低分子肝素疗效分析。方法：回顾性分析2021年1月~2022年11月于青岛大学脊柱外科收治并实施后路单节段腰椎椎间融合术(Posterior lumbar interbody fusion, PLIF)手术的腰椎退变性疾病病人171例，根据手术24小时后是否开始应用低分子肝素皮下注射分为实验组90例和对照组81例，术前经双下肢血管彩色多普勒超声检查确认均无血栓形成；实验组均自手术24小时后开始应用低分子肝素5000 IU皮下注射，1次/日，进行抗凝治疗，至下地活动后停用。所有病人均于术后下地活动时复查血凝及部分进行双下肢血管超声评估有无DVT形成。观察两组病人术后DVT的发生率、术后切口引流量、伤口血肿情况及D-二聚体等情况。结果：对照组病人中术后未发生DVT，2例出现下肢肌间静脉血栓，发生率约为2.5% (2/81)；实验组病人术后未发生DVT。实验组和对照组病人术后切口引流量分别为358.56 mL和354.32 mL，实验组的术后引流略多于对照组，差异没有统计学意义，应用低分子肝素并不明显增加术后引流量，实验组的D-二聚体的增长幅度为224.44，对照组的D-二聚体的增长幅度为380.99，差异有统计学意义(P < 0.05)，实验组的D-二聚体增长幅度明显小于对照组，均未见椎管内及切口血肿及无术后神经损伤症状。结论：腰椎退变性疾病病人往往手术后存在下肢静脉血栓形成风险，可常规预防性应用低分子肝素，术后未出现切口引流量增多及血肿形成等明显并发症。

Abstract: Objective: To investigate the efficacy of postoperative prophylactic application of low molecular heparin in posterior single-segment lumbar interbody fusion. Methods: 171 patients with lumbar degenerative diseases who were admitted to the Department of Spine Surgery of Qingdao University and underwent posterior single-segment lumbar interbody fusion (PLIF) from January 2021 to November 2022 were retrospectively analyzed and divided into 90 cases in the experimental group and 81 cases in the control group according to whether or not they started to apply low-molecular heparin subcutaneously 24 hours after surgery. The experimental group consisted of 90 patients and the control group consisted of 81 patients, all of whom were confirmed to be free of thrombosis by color Doppler ultrasound examination of the blood vessels of both lower limbs before the operation; the experimental group was treated with anticoagulation by subcutaneous injections of 5000 IU of low molecular heparin once a day starting 24 hours after the operation, and then discontinued after going down to the ground for activities. All patients were rechecked for blood coagulation and some of them underwent bilateral lower extremity vascular ultrasound to evaluate the presence of DVT formation at the time of postoperative activities. The incidence of postoperative DVT, postoperative incisional drainage, wound hematoma and D-dimer were observed in both groups. Results: In the control group, no DVT occurred after surgery, but 2 cases of intermuscular vein thrombosis in the lower limbs occurred, and the incidence rate was about 2.5% (2/81); in the experimental group, no DVT occurred after surgery; the postoperative incisional drainage flow of the experimental group and the control group was 358.56 mL and 354.32 mL, respectively, and the postoperative drainage flow of the experimental group was slight-ly more than that of the control group, but the difference was not statistically significant, and the application of low molecular heparin did not significantly increase the postoperative drainage flow, and the application of low molecular heparin did not significantly increase the postoperative drainage flow. The application of low molecular heparin did not significantly increase the postoper-ative drainage flow. The increase of D-dimer in the experimental group was 224.44, and the in-crease of D-dimer in the control group was 380.99, and the difference was statistically significant (P < 0.05), and the increase of D-dimer in the experimental group was significantly smaller than that of the control group, and there were no intradural and incisional hematomas and no symptoms of postoperative neurological injury. Conclusion: Patients with lumbar degenerative diseases are often at risk of lower extremity venous thrombosis after surgery, and low molecular heparin can be ap-plied routinely and prophylactically, and no obvious complications such as increased incisional drainage and hematoma formation were seen after surgery.