病例报告

椎体骨折合并活化部分凝血活酶时间延长1例

  • 白心竹 ,
  • 何金徽 ,
  • 陆松松 ,
  • 李春 ,
  • 王依林 ,
  • 熊建
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  • 1. 北京大学人民医院创伤骨科, 国家创伤医学中心, 北京 100044
    2. 浙江省人民医院毕节医院创伤科, 贵州毕节 551799
    3. 北京大学人民医院检验科, 北京 100044
    4. 北京大学人民医院风湿免疫科, 北京 100044

收稿日期: 2023-04-21

  网络出版日期: 2024-04-10

Vertebral fractures combined with prolonged activated partial prothrombin time: A case report

  • Xinzhu BAI ,
  • Jinhui HE ,
  • Songsong LU ,
  • Chun LI ,
  • Yilin WANG ,
  • Jian XIONG
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  • 1. Department of Trauma and Orthopaedics, Peking University People's Hospital; National Center for Trauma Medicine, Beijing 100044, China
    2. Department of Trauma, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie 551799, Guizhou, China
    3. Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China
    4. Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China

Received date: 2023-04-21

  Online published: 2024-04-10

本文引用格式

白心竹 , 何金徽 , 陆松松 , 李春 , 王依林 , 熊建 . 椎体骨折合并活化部分凝血活酶时间延长1例[J]. 北京大学学报(医学版), 2024 , 56(2) : 371 -374 . DOI: 10.19723/j.issn.1671-167X.2024.02.028

Abstract

With the development of modern medical standards, autoimmune diseases and their associated successive osteoporosis have received increasing attention in recent years. Patients with autoimmune diseases, due to the characteristics of the disease and the prolonged use of glucocorticoid hormone therapy, may affect the bone formation and bone absorption of the patient, followed by severe successive osteoporosis, thereby increasing the risk of osteoporotic vertebral fractures. Vertebral compression fractures of the spine are common fracture types in patients with osteoporotic fractures. Osteoporosis is a common complication after glucocorticoid therapy in patients with autoimmune diseases. Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are minimally invasive operation and are commonly used surgical methods for the treatment of osteoporotic vertebral compression fractures. However, due to the operation of spinal puncture during the operation, there are serious surgical risks such as bone cement leakage, spinal epidural hemorrhage, subdural hemorrhage, and subarachnoid hemorrhage in both PVP and PKP. As a result, it is necessary to evaluate the patient' s body before surgery carefully, especially in the case of blood coagulation. This article reports a case of autoimmune disease patient admitted to Peking University People' s Hospital due to lumbar 4 vertebral compression fracture combined with Sjögren' s syndrome. The patient' s preoperative examination showed that the activated partial thromboplastin time (APTT) was significantly prolonged. After completing the APTT extended screening experiment and lupus anticoagulant factor testing, the multi-disciplinary team (MDT) of Peking University People' s Hospital jointly discussed the conclusion that the patient' s test results were caused by an abnormal self-immunity anti-copulant lupus (LAC). Based on the results of the laboratory examination, the patient was considered to be diagnosed with combined antiphospholipid syndrome (APS). For such patients, compared with the patient' s tendency to bleed, we should pay more attention to the risk of high blood clotting in the lower limbs of the patient, pulmonary clots and so on. With timely anti-coagulation treatment, the patient safely passed the peripheral period and was successfully discharged from the hospital. Therefore, for patients with autoimmune diseases with prolonged APTT in the perioperative period, doctors need to carefully identify the actual cause and carry out targeted treatment in order to minimize the risk of surgical and perioperative complications and bring satisfactory treatment results to the patients.

参考文献

1 Kutsal FY , Ergin Ergani GO . Vertebral compression fractures: Still an unpredictable aspect of osteoporosis[J]. Med Sci, 2021, 51 (2): 393- 399.
2 Dineen R , Behan LA , Kelleher G , et al. The contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapy[J]. BMC Endocr Disord, 2020, 20 (1): 154.
3 Adami G , Fassio A , Rossini M , et al. Osteoporosis in rheumatic diseases[J]. Int J Mol Sci, 2019, 20 (23): 5867.
4 Beall DP , Chambers MR , Thomas S , et al. Prospective and multicenter evaluation of outcomes for quality of life and activities of daily living for balloon kyphoplasty in the treatment of vertebral compression fractures: The EVOLVE trial[J]. Neurosurgery, 2019, 84 (1): 169- 178.
5 Wang P , Li J , Song Z , et al. Utilization of the directional balloon technique to improve the effectiveness of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures and reduction of bone cement leakage[J]. Medicine (Baltimore), 2019, 98 (19): e15272.
6 Shi X , Cui Y , Pan Y , et al. Prediction of early vascular cement leakage following percutaneous vertebroplasty in spine metastases: The Peking University First Hospital Score (PUFHS)[J]. BMC Cancer, 2021, 21 (1): 764.
7 Qin B , Wang J , Yang Z , et al. Epidemiology of primary Sj?gren' s syndrome: A systematic review and meta-analysis[J]. Ann Rheum Dis, 2015, 74 (11): 1983- 1989.
8 Petri M . Antiphospholipid syndrome[J]. Transl Res, 2020, 225, 70- 81.
9 Pariente E , Olmos JM , Landeras R , et al. Relationship between spinal osteoarthritis and vertebral fractures in men older than 50 years: Data from the Camargo cohort study[J]. J Bone Miner Metab, 2017, 35 (1): 114- 121.
10 Rzewuska M , Ferreira M , McLachlan AJ , et al. The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: A systematic review with meta-analysis[J]. Eur Spine J, 2015, 24 (4): 702- 714.
11 Noguchi T , Yamashita K , Shida Y , et al. Accuracy of vertebral puncture in percutaneous vertebroplasty[J]. Jpn J Radiol, 2022, 40 (4): 419- 429.
12 Noguchi T , Yamashita K , Kamei R , et al. Current status and challenges of percutaneous vertebroplasty (PVP)[J]. Jpn J Radiol, 2023, 41 (1): 1- 13.
13 Rasmussen KL , Philips M , Tripodi A , et al. Unexpected, isolated activated partial thromboplastin time prolongation: A practical mini-review[J]. Eur J Haematol, 2020, 104 (6): 519- 525.
14 Jedryka-Goral A , Jagiello P , D'Cruz DP , et al. Isotype profile and clinical relevance of anticardiolipin antibodies in Sj?gren' s syndrome[J]. Ann Rheum Dis, 1992, 51 (7): 889- 891.
15 Martinelli I , Abbattista M , Bucciarelli P , et al. Recurrent thrombosis in patients with antiphospholipid antibodies treated with vitamin K antagonists or rivaroxaban[J]. Haematologica, 2018, 103 (7): e315- e317.
16 Pasoto SG , Chakkour HP , Natalino RR , et al. Lupus anticoagulant: A marker for stroke and venous thrombosis in primary Sj?gren's syndrome[J]. Clin Rheumatol, 2012, 31 (9): 1331- 1338.
17 Borhan S , Papaioannou A , Gajic-Veljanoski O , et al. Incident fragility fractures have a long-term negative impact on health-rela-ted quality of life of older people: The Canadian multicentre osteoporosis study[J]. J Bone Miner Res, 2019, 34 (5): 838- 848.
18 Aspray TJ , Hill TR . Osteoporosis and the ageing skeleton[J]. Subcell Biochem, 2019, 91, 453- 476.
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