脊椎手術後の深部静脈血栓症（DVT）の検討

Study of Deep Venous Thrombosis after Spinal Surgery

　抄録：2000年4月から2002年4月までに，脊椎手術後に下肢静脈造影を行った42例を対象としてDVTの発生率と発生高位および年齢，性別，肥満度，手術時間，出血量，Dダイマー値との関連を検討した．Dダイマー値は術翌日と術後7日に測定した．静脈造影の結果，12例（28.6％）がDVT陽性であった．しかし，全例無症候性であった．発生高位は近位型3例（7.1％），遠位型9例（21.4％）であった．DVT陽性群と陰性群の比較では，年齢，性別，肥満度，手術時間，出血量に有意差はみられなかった．Dダイマー値は術後1日で，有意な差は認めなかったが，術後7日でDVT陽性群12.7±2.63μg/ml，DVT陰性群4.8±0.54μg/mlとDVT陽性群で有意に高値であった（p＜0.01）．特にDVT陽性群のなかでも，末梢型よりも中枢型で有意に高値であった．Dダイマー値は脊椎手術後のDVT発症の重要な指標となりうる．

　The rate of postoperative deep venous thrombosis (DVT) after spinal surgery, its risk factors,and the postoperative values of D-dimer as a molecular marker of fibrinolysis were investigated in 42 cases of spinal surgery performed at our hospital between April 2000 and the end of April 2002. DVT was detected by venography a average of 11.4 days after surgery. DVT developed in 12 (28.6％) of the 42 cases, and it was the proximal type in 3 (7.1％) and the distal type in 9 (21.4％). The DVT was asymptomatic in every case. There were no significant differences between the age, sex, body mass index, duration of surgery, or blood loss in the DVT positive and negative cases. The D-dimer values one day after surgery were not significantly higher in the DVT cases. However, seven days after surgery, the D-dimer values in the DVT cases were 12.7±2.63μg/ml, as opposed to 4.8±0.54μg/ml in the cases without DVT, and the values in the DVT group were significantly higher (p＜0.01). It was especially noteworthy that the values in the proximal type cases of DVT were higher than in the cases of the distal type (p＜0.05). Measurement of D-dimer is a useful method of screening for DVT after spinal surgery.