D-dimerによる脊椎手術後血栓症スクリーニング

D-dimer in the Diagnosis of Thromboembolic Disease after Spinal Surgery

　脊椎手術を行った136名に対して術後血栓症のスクリーニングとしてD-dimerを測定した．D-dimerは術後3日目，7日目に測定し，カットオフ値を10μg/mlに設定し，カットオフ値を超えた症例に対して造影CTを行った．カットオフ値を超えた症例は14例であり，13例に固定術が行われ，そのうち2例に肺塞栓を認めた．2例とも前方操作を行った症例であった．脊椎手術の中でも前方操作がある症例においては，現在行っている下肢静脈血栓の予防だけでは十分ではない可能性がある．

　The plasma D-dimer levels of 136 patients (80 men and 56 women, mean age 63.9 years) who underwent spinal surgery in our hospital were measured on pod 3 and pod 7, as a method of screening for thromboembolic disease.　A D-dimer cut off value of 10μg/dl was used and only the patients with higher values were examined by CT.　No patients had symptomatic thromboembolic disease.　On pod 7 the D-dimer levels of 14 patients was above 10μg/dl, but only 2 of them were detected in asymptomatic pulmonary embolism.　Both of them had undergone anterior fusion surgery, and no deep venous thrombosis was detected in the lower extremities.　Anticoagulation therapy with heparin and warfarin was started immediately, and the patients were discharged symptom-free.　Another methods of thromboprophylaxis in addition to traditional mechanical thromboprophylaxis, such as by wearing compression stockings and foot pumps, may be necessary after anterior spinal surgery.