退变性脊柱侧凸后路长节段固定融合术后早期并发症危险因素分析  

Risk factors analysis of early complications in posterior long-level fusion and fixation for adult degenerative scoliosis

作　　者：刘寅昊 袁磊[1] 曾岩[1] 张心灵 陈仲强[1] 李危石[1] 郭昭庆[1] 齐强[1] LIU Yinhao;YUAN Lei;ZENG Yan(Peking Iniversity Third Hospital,Department of Orthopaedics,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research,Beijing,100191,China)

机构地区：[1]北京大学第三医院骨科骨与关节精准医学工程研究中心脊柱疾病研究北京市重点实验室,北京市100191

出　　处：《中国脊柱脊髓杂志》2021年第5期441-449,共9页Chinese Journal of Spine and Spinal Cord

基　　金：2016年北京市自然科学基金资助项目(编号:7162198)。

摘　　要：目的:探讨成人退变性脊柱侧凸(adult degenerative scoliosis,ADS)后路长节段融合固定术后早期并发症的相关危险因素。方法:收集了216例在我院行后路长节段(≥4节段)固定融合术的ADS患者的临床资料,根据术后6周内是否出现并发症分为早期并发症组和无并发症组。比较两组患者围术期相关资料,一般资料包括性别、年龄、腰腿症状时间、既往内科病病史、是否吸烟、骨质疏松T值、美国麻醉医师学会(American Society of Anesthesiologists,ASA)麻醉风险分级等;手术资料包括手术时间、固定融合节段数、截骨分级、术中失血量等;术后资料包括患者术后是否出现并发症、并发症具体情况、术后引流量、患者术后红细胞计数及血红蛋白量等。比较两组间各指标差异并通过单因素Logistic回归分析来发现潜在危险因素,多因素Logistic回归分析筛选发生早期并发症的独立危险因素。结果:89例患者纳入早期并发症组,127例患者纳入无并发症组。腰痛病程(P=0.034)、术后第1天红细胞计数(P=0.017)、麻醉时间(P<0.001)、手术时间(P<0.001)、固定融合节段数量(P<0.001)、术中行截骨术(P=0.027)、不同截骨级别(P=0.002)、截骨节段(P=0.049)、术中失血量(P=0.048)、术中尿量(P=0.022)、术中总输入液体量(P=0.005)、自体血回输量(P=0.022)、术后总引流量(P<0.001)、住院时间(P<0.001)两组间存在统计学差异(P<0.05)。单因素Logistic回归分析显示,固定融合节段长、手术时间长、术中失血量多、术中总输入液体量多、3级及以上截骨术、自体血回输量多、术后总引流量多、术后第1天红细胞计数较低为早期并发症的潜在危险因素,多因素Logistic回归分析显示,较多的术后总引流量、3级及以上截骨为术后早期并发症的独立危险因素。进行3级及以上截骨患者出现早期并发症的风险为进行3级以下截骨或未进行截骨患者的4.577倍(P=0.Objectives:To investigate the risk factors of early complications during posterior long-level instrumentation in the treatment of adult degenerative scoliosis(ADS).Methods:The data of 216 patients with ADS who underwent posterior long-segmental instrumentation(≥4 levels)were reviewed retrospectively.According to whether complications occurred within 6 weeks or not after operation,the patients were divided into the early complications group and non-early complications group.The perioperative data of the two groups were compared.General data included gender,age,duration of lumbar and leg symptoms,past medical histo ry,smoking history,T-value of osteoporosis,and preoperative classification by American Society of Anesthesiologists(ASA).The operative data included operation time,number of fixation and fused levels,osteotomy grade,and intraoperative blood loss.Postoperative data included whether there were postoperative complications,the situation of complications,volume of drainage,postoperative red blood cell count,and hemoglobin level.Potential risk factors were identified by univariate logistic regression analysis after comparing the difference of clinical data in the two groups.Multivariate logistic regression analysis was performed to verify the independent risk factors of early complications.Results:There were 89(41.2%)patients enrolled in the early complications group,and 127(58.8%)in the control group.There were statistically significant differences between the two groups(P<0.05)in terms of the duration of low back pain(P=0.034),count of red blood cell on the first day after surgery(P=0.017),anesthesia time(P<0.001),operation time(P<0.001),fixation and fusion levels(P<0.001),intraoperative osteotomy(P=0.027),the osteotomy grade(P=0.002)and level(P=0.049),intraoperative blood loss(P=0.048),intraoperative urinary volume(P=0.022),total intraoperative input liquid(P=0.005),volume of autologous blood transfusion(P=0.022),postoperative drainage volume(P=0.002),and hospital stay(P<0.001).These parameters were analy

关 键 词：退变性脊柱侧凸 早期并发症 长节段固定 危险因素 

分 类 号：R687.3[医药卫生—骨科学] R619[医药卫生—外科学]