脊柱转移性肿瘤后路360度减压内固定手术时间和出血量的影响因素分析  

Influence factors of operation time and blood loss during single-stage posterior transpedicular approach for circumferential decompression and instrumented stabilization with vertebrectomy reconstruction for spinal metastatic tumor

作　　者：金永明[1] 郑嘉寅 张骏[1] 绍海宇 杨迪[1] 陈初勇[1] 黄亚增[1] 李晓林[1] 陈锦平[1] 

机构地区：[1]浙江省人民医院脊柱外科,杭州310014 [2]北京大学理学院统计系

出　　处：《浙江医学》2014年第6期489-493,共5页Zhejiang Medical Journal

基　　金：浙江省公益技术应用研究项目(2012C3069)

摘　　要：目的分析影响脊柱转移性肿瘤一期后路单切口360度减压椎体切除重建内固定术的手术时间和出血量的因素。方法分析2007—2012年48例脊柱转移性肿瘤患者在接受同一组高年资医生做的后路经椎弓根途径行一期后路单切口360度减压椎体切除重建内固定术的12个可能影响因素:手术顺序、性别、年龄、肿瘤类型、术前神经功能的Frankel分级、肿瘤血管丰度、切除椎体的部位、椎体切除的节段数、内固定节段数、椎弓根累计数、TPA人路的途径、钛网的类型等。观察其对手术时间和手术估计出血量的影响。结果随着手术顺序和患者年龄的增加,手术时间明显减少(P<0.01)。≤4节段的内固定明显比>4节段内固定的手术时间少,2、4和6节段手术时间分别为(2.85±0.22)、(4.11±1.25)和(6.42±1.25)h(P<0.01)。而2节段和4节段固定的手术时间差异无统计学意义(P>0.05)。血供丰富的肿瘤组出血量[(4171.42±992.83)ml]明显较非血供丰富组术中出血量要大[(1367.07±706.72)ml,P<0.01],差异有统计学意义。应用可撑开钛网[(1581.25±1409.97)ml]进行前柱重建比非可撑开钛网[(1970.83±1776.04)ml]的出血量要少,差异有统计学意义(P<0.05)。未发现其他因素对手术时间和出血量的影响。结论影响手术时间的因素包括手术顺序、患者年龄、内固定节段数,结果支持≤4节段的内固定。影响出血量的因素包括肿瘤血管丰度和钛网类型,应推荐应用可撑开钛网进行前柱重建。Objective To investigate influencing factors of operation time and blood loss during single-stage posterior transpedicular approach for circumferential decompression and instrumented stabilization with vertebrectomy reconstruction for spinal metastatic tumor. Methods Data were collected from 48 consecutive patients undergoing single-stage posterior transpedicular approach for circumferential decompression and instrumented stabilization with vertebrectomy reconstruction for spinal metastatic tumor by one senior surgeon. The influence of 12 related factors on the operation times and/or blood losses dur- ing the surgical procedures were examined. The statistical analysis was performed using SAS version 9.1. Results The order of operation and the age of operation was related to operation time significantly （F=42.45 and 18.41 respectively, both P〈0.01）. The operation time for 2, 4 and 6-segmental fixation levels were 2.85 ± 0.22, 4.11 ± 1.25 and 6.42 ＋ 1.25h, respectively; there was sig- nificant difference between 6-segmental fixation and 4 or less-segmental fixation （F= 10.36, P〈0.01）, while there was no signifi- cant difference between 2 and 4 segmental fixation （P 〉0.05）. The blood loss of hypervascular tumors was greater than that of non-hypervascular tumors （4 171.42 ± 992.83ml vs 1 367.07 ±706.72ml, F=32.03, P〈0.01）. Expandable cages used for anterior vertebral column reconstruction significantty decreased blood loss compared with un-expandable meshes （1 581.25 ±1 409.97ml vs 1 970.83± 1 776.04ml, F=5.90, P〈0.05）. Conclusion The order of operation, age of patients and the number of vertebrae fixed would influence the operation time; and the hypervascular tumors and using un-expandable meshes would increased blood loss during the operation.

关 键 词：影响因素手术时间 出血量脊柱转移性肿瘤后路经椎弓根入路 

分 类 号：R738.1[医药卫生—肿瘤]