颈、胸椎手术中医源性脊髓损伤的危险因素分析  

Risk factors of iatrogenic spinal cord injury during cervical or thoracic spinal surgery

作　　者：张宏其[1] 盛斌[2] 黄术[2] 邓盎[1] 王昱翔[1] 吴建煌[1] 刘金洋[1] 葛磊[1] 陈静[1] 王锡阳[1] 

机构地区：[1]中南大学湘雅医院脊柱外科、湘雅脊柱外科中心,长沙410008 [2]湖南省人民医院骨科

出　　处：《中华创伤杂志》2011年第8期673-678,共6页Chinese Journal of Trauma

基　　金：国家“十一五”科技支撑计划资助项目（2007BAI04B07）

摘　　要：目的分析颈、胸椎手术中可能导致医源性脊髓损伤（iatrogenic spinal cord injury，ISCI）的危险因素，为减少手术中脊髓损伤提供理论依据。方法回顾性调查2002年1月-2009年1月行颈、胸椎（C1～T12）手术患者120例，按随机数字表法分为损伤组（34例）和对照组（86例），对两组临床因素、影像学因素、手术和病理因素及可能的保护因素等共30个变量进行单因素分析，对差异有统计学意义的指标进行多因素非条件Logistic回归分析。结果两组单因素比较显示，合并高血压、合并糖尿病、术前美国脊髓协会（ASIA）损伤分级、椎管狭窄率、脊髓／有效椎管面积比值、脊髓MRI T2W1高信号、术中出血量、椎管内突出物与硬膜粘连及术中使用甲基强的松龙（methylprednisolone，MP）等9个变量差异有统计学意义（P〈0．05）。Logistic回归分析显示合并糖尿病、术前ASIA损伤分级、脊髓／有效椎管面积比值、脊髓MRI T2W1高信号、术中出血量与ISCI呈正相关，术中使用MP与ISCI呈负相关。结论合并糖尿病、ASIA损伤分级、脊髓MRI T2W1高信号、脊髓／有效椎管面积比值、术中出血量为ISCI的危险因素，术中使用MP对ISCI的发生有预防作用。Objective To find out the risk factors causing iatrogenic spinal cord injury （ISCI） so as to provide theoretical support for reducing the spinal cord injury during spinal operation. Methods A retrospective study was done on 120 patients undergone cervical or thoracic spinal（ C1-T12 ） surgery at Xiangya Hospital of Central South University from January 2002 to January 2009. The patients were ran- domly divided into injury group （ n = 34） and control group （ n = 86） and the univariate analysis was used to analyze 30 factors including clinical factors, iconography factors, operation and pathology factors as well as possible protective factors. Then, the factors with statistical difference were analyzed by using the multi-factor unconditioned Logistic analysis. Results The univariate comparison between the two groups showed statistical difference （P 〈 0.05 ） in nine factors including combined hypertension, com- bined diabetes mellitus, preoperative ASIA grade, spinal canal stenosis rate, ratio of spinal cord area/efficient area of vertebral canal, spinal cord MRI T2W1 high signal, bleeding amount during operation, intraspinal prominence adhesion to dura mate of spinal cord as well as intraoperative use of methylprednisolone. The multi-factor Logistic regression analysis revealed that ASIA grade, value of spinal cord area/efficient area of vertebral canal, spinal cord MRI T2W1 high signal and bleeding amount in operation had positive correlation with ISCI. Use of methylprednisolone during operation had negative correlation with ISCI. Conclusions Combined diabetes mellitus, ASIA grade, spinal cord MRI T2W1 high signal, ratio of spinal cord/vertebral canal area and bleeding amount in operation are the risk factors for ISCI. Use of large dose methylprednisolone exerts preventive effect on ISCI.

关 键 词：脊髓损伤 危险因素 外科手术 

分 类 号：R651.2[医药卫生—外科学]