后路腰椎椎间融合术后早期并发深静脉血栓形成的相关因素分析  

Correlation factors analysis for early deep venous thrombosis after posterior lumbar interbody fusion

作　　者：姚晓光[1] 申勇[1] 张英泽[1] 丁文元[1] 董玉昌[1] 张为[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,河北省石家庄市050051

出　　处：《中国脊柱脊髓杂志》2008年第12期910-914,共5页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨后路腰椎椎间融合(PLIF)术后早期并发深静脉血栓形成(DVT)的相关因素。方法:2004年1月～2007年1月我院共有1196例患者行PLIF手术,其中29例患者术后1个月内并发症状性DVT,对术后并发DVT组和未并发DVT组患者的年龄、体重、合并症、术前凝血四项、D-二聚体、固定融合节段数、手术时间、输血情况、麻醉方式、术后卧床时间、术后双下肢主被动功能锻炼情况、术后抗血栓药物应用情况进行Logistic多变量回归分析,探讨DVT的危险因素和保护因素。结果:高龄、肥胖、合并症、术前凝血功能亢进、D-二聚体增高、双节段以上固定融合、手术时间长、全身麻醉、输血及术后卧床时间长是PLIF手术后发生DVT的危险因素,其OR值分别为4.075、7.803、46.176、0.101、0.082、5.219、9.628、0.121、5.068和5.199(P<0.05);硬膜外麻醉、术后双下肢主被动功能锻炼及术后抗血栓药物应用可使术后发生DVT的风险降低,其OR值分别为0.121、0.114和0.093(P<0.05)。结论:PLIF术后早期并发深静脉血栓形成的因素是多方面的,应通过加大保护因素的作用来预防DVT的发生。Objective：To explore the correlation factors of early deep venous thrombosis（DVT） secondary to posterior lumbar interbody fusion （PLIF）.Method：A total of 1196 cases in our institute experienced PLIF procedure from January 2004 to January 2007,of these,29 patients were complicated with early deep venous thrombosis（DVT） one month after PLIF.The status of age,weight,peripheral surgical complications,blood clotting function, D-dimer,fused levels,operating time,blood transfusion, anaesthesia,post-operative bed time,function of lower extremities and anti-thrombosis drug postoperatively between group complicated with DVT and group without DVT were reviewed retrospectively.All factors associated were analyzed by Logistic multivariate regression analysis using SPSS 12.0 statistics software.Result：Advanced age,obesity,complication,high blood coagulation status,high D-dimer,more than two levels fused,long operating time,general anaesthesia,blood transfusion and long bed time were associated with the oceerrunce of DVT postoperatively,with the OR value of 4.075,7.803,46.176,0.101,0.082,5.219,9.628,0.121,5.068 and 5.199 respectively （P〈0.05）.Extradural anaesthesia, active exercise of lower extremeties and use of anti-coagulate medicine can lower the risk of DVT postoperatively,with the OR value of 0.121,0.114 and 0.093 respectively（P〈0.05）.Conclusion：Multifaetors are associated with early DVT after PLIF. Which can be prevented by strengthing protective factors.

关 键 词：后路腰椎椎间融合 深静脉血栓形成 相关因素 

分 类 号：R681.5[医药卫生—骨科学] R619[医药卫生—外科学]