脊椎手術後の肺塞栓症と深部静脈血栓症の検討

Pulmonary Embolism and Deep Venous Thrombosis after Spinal Surgery

　抄録：脊椎手術後の合併症としての肺塞栓症（以下PE），臨床的深部静脈血栓症（以下DVT）につき検討した．対象は前方固定術6例，開窓術20例，PLIF10例の計36例で前方固定術以外は腹臥位で行った．PEの診断は肺血流シンチグラムで行い，術前と比べ術後1～2週で新たな欠損像を示すものとし，DVTは疼痛，腫脹，圧痛，Homans徴候のある例とした．脊椎手術におけるPE，臨床的DVTの発生頻度と血液ガス，凝固線溶系マーカー（TAT，D-dimer）の有用性につき検討した．PE，臨床的DVTはそれぞれ2例（5.6％）に認めたが，両者の同時発生はなかった．PEは無症候性であったが，PaO₂は術後1週で約20％低下し，D-dimer値は2週時に高値を示した．脊椎手術におけるPE，DVTの発生頻度は必ずしも低くはなく，これらの合併症を常に念頭に置き治療にあたる必要がある．脊椎手術後のPE，DVTのスクリーニングとして，血液ガス分析，D-dimer測定は低コスト，低侵襲で有用であった．

　The incidence of pulmonary embolism (PE) and deep venous thrombosis (DVT) in 36 patients after lumbar spinal surgery was investigated. Anterior spinal fusion (ASF) had been performed in 6 cases, fenestration in 20 cases, and posterior interbody fusion (PLIF) in 10 cases. Fenestration and PLIF were performed in the prone position. PE was diagnosed by lung perfusion scans, and DVT on the basis of clinical signs. The blood gas analysis data and serum TAT and D-dimer levels were examined following surgery. PE and symptomatic DVT had occurred in each 2 cases (5.6％). Although PE cases were asymptomatic, the PaO₂level decreased 20％on postoperative day 7, and D-dimer was significant increased on postoperative day 14. It should be noted that PE and DVT are not very rare after spinal surgery, and it is important to diagnose them earlier and to prevent them. Blood gas analysis and determination of D-dimer levels after spinal surgery are useful for early detection of PE.