Clinical Study Of The Changes Of D-dimer And Its Relationship With Deep Venous Thrombosis After Spinal Surgery

Objective:Explore the changes of D-dimer concentration and its relationship with deep venous thrombosis after spinal surgery.Methods:Collecting the 165 patients underwent spinal surgery during September 2015 to January 2017 from the Department of spinal at the hospital,including 98 male and 67 female,aged 26-84 years,range: 53.32±11.66 years.14 cases of cervical disc herniation,13 cases of cervical stenosis,2 cases of thoracic spinal stenosis,62 cases of lumbar disc herniation,17 cases of lumbar spinal stenosis,8 cases of lumbar spondylolisthesis,2 cases of scoliosis,spinal injury in 47 cases with 20 cases spinal cord injury.The D-dimer two was measured in all patients before operation and at 1 day,3 days,7 days,14 days after operation.All patients in the preoperative examination of vascular ultrasound to exclude DVT,postoperative suspected DVT with immediate review of the dvascular ultrasound,the remaining patients examined dvascular ultrasound at 7 days,14 days after operation.Patients with DVT after operation were divided into thrombosis group,without DVT were classified as non thrombus group.Statistical analysis were performed using the SPSS 22.0,and P<0.05 was considered to be statistically significant.Results:There were 12 cases of DVT after operation in the 165 patients,the incidence of DVT was 7.27%,and there was no pulmonary embolism case.Including 7 cases of plexus venosus leg muscle thrombosis,2 cases of peroneal vein thrombosis,2 cases of posterior tibial vein thrombosis,There were 2 patient with DVT was found at 6 day after operation,5 patients with DVT was found at 7 days after operation,3 patient with DVT was found at 8 days after operation and 2 patients with DVT was found at 9 days after operation.At 1,3,7 and 14 days after operation,the concentration of D-dimer in the thrombus group and the non thrombus group was both significant higher than that before the operation(P<0.01).There was no significant difference in the concentration of D-dimer between thrombus group and non thrombus group before the operation(P>0.05).At 1,3,7 and 14 days after operation,the concentration of D-dimer in the thrombus group was significantly higher than that in the non thrombus group(P<0.01).After the operation,the concentration of D-dimer in the non thrombus group increased slightly and reached the peak at 3 days after the operation,and then gradually decreased to the normal range at 14 days after the operation.The concentration of D-dimer in the thrombus group increased significantly and reached the peak at 7 days after the operation,and then gradually decreased but did not to the normal range at 14 days after the operation.The ROC curve was drawn.The area under the curve(AUC)was 0.768 at 1 day after operation and the optimal critical value of D-dimer was 2.00ug/ml,the sensitivity was 91.7%,specificity was 55.6%.The area under the curve(AUC)was 0.786 at 3 days after operation and the optimal critical value of D-dimer was 4.42ug/ml,the sensitivity was 66.7%,specificity was 80.4%.The area under the curve(AUC)was 0.943 at 7 days after operation and the optimal critical value of D-dimer was 4.71ug/ml,the sensitivity was 83.3%,specificity was 92.2%.Conclusion:1.The incidence rate of DVT was 7.27% on functional exercise after spinal surgery.2.The risk of DVT was highest from 6 to 9 days after spinal surgery,and the concentration of D-dimer was the most valuable for the diagnosis of DVT at 7 days after spinal surgery.3.The optimal critical value of D-dimer was 4.71ug/ml with the sensitivity of 83.3% and the specificity of 92.2% after spinal surgery.