单侧双通道内镜下腰椎融合术后椎管内血肿的发生情况及其危险因素分析  

Characteristics and risk factors of spinal epidural hematoma after unilateral biportal endoscopic lumbar interbody fusion

作　　者：梁昌详[1] 梁国彦[1] 刘海峰 郑晓青[1] 肖丹 黄勇兄 陈崇 余涛 尹东[1] 昌耘冰[1] Liang Changxiang;Liang Guoyan;Liu Haifeng;Zheng Xiaoqing;Xiao Dan;Huang Yongxiong;Chen Chong;Yu Tao;Yin Dong;Chang Yunbing(Department of Spine Surgery,Guangdong Provincial People′s Hospital,Guangzhou 510080,China;Department of Orthopedics,Xingning People′s Hospital of Guangdong Province,Meizhou 514500,China)

机构地区：[1]广东省医学科学院,广东省人民医院脊柱外科,广州510080 [2]广东省兴宁市人民医院骨科,梅州514500

出　　处：《中华医学杂志》2022年第41期3267-3273,共7页National Medical Journal of China

基　　金：国家自然科学基金(8217090430);广州市科技计划重点研发项目(202103000053)。

摘　　要：目的研究单侧双通道内镜(UBE)下腰椎融合术后椎管内血肿的发生率、特点及危险因素。方法回顾性分析2020年2月至2021年3月在广东省人民医院接受UBE下腰椎融合术的105例患者的临床资料。其中男48例(45.7%),女57例(54.3%),年龄(60.1±11.4)岁(26~85岁)。观察术后3 d内的MRI影像,统计血肿的发生情况。根据是否发生血肿将患者分为正常组及血肿组。收集各组患者的各项临床指标,分析比较两组各指标间的差异。利用单因素回归分析分析与UBE下腰椎融合术后椎管内血肿发生相关的因素,然后将其中P<0.1的因素纳入logistic逐步回归模型分析血肿发生的相关因素。结果总血肿的发生率为28.6%(30/105),症状性血肿发生率为6.7%(7/105),血肿再手术率为0.9%(1/105)。单因素logistic回归分析显示,高血压病(OR=3.368,95%CI:1.389~8.171),糖尿病(OR=3.589,95%CI:1.230~10.476),入院血压收缩压>140 mmHg(1 mmHg=0.133 kPa,OR=3.687,95%CI:1.493~9.017),血小板<200×10^(9)/L(OR=0.300,95%CI:0.119~0.785),术前血钙值<2.25 mmol/L(OR=0.340,95%CI:0.142~0.818),椎管狭窄分级为D级(OR=4.462,95%CI:1.810~10.996)等因素是导致UBE下腰椎融合术后椎管内血肿可能的危险因素。采用多因素logistic逐步回归分析显示,入院血压收缩压>140 mmHg(OR=3.788,95%CI:1.055~13.606)、术前血钙值<2.25 mmol/L(OR=78.544,95%CI:3.895~1584.058)及椎管狭窄分级为D级(OR=3.698,95%CI:1.110~12.325)等是导致UBE下融合术后椎管内血肿的相关因素(均P<0.05)。结论UBE下腰椎融合术后椎管血肿有局限型及蔓延型两种类型。导致血肿的危险因素包括入院血压收缩压高、术前血钙低及严重椎管狭窄。Objective To investigate the incidence,characteristics and risk factors of spinal epidural hematoma after unilateral biportal endoscopic(UBE)lumbar spine surgery.Methods The clinical data of 105 patients who underwent lumbar spine surgery under UBE in Guangdong Provincial People′s Hospital from February 2020 to March 2021 were retrospectively reviewed.Of the patients,48(45.7%)were male and 57(54.3%)were female,the mean age was(60.1±11.4)years(ranged 26 to 85 years).The MRI images at the third day post-surgery were observed,and the occurrence of hematoma was counted.Patients were assigned to normal group and hematoma group based on the presence of hematoma or not.The related clinical indicators of each patients were collected and used for comparison between two different groups.Logistic stepwise regression model was used to analyze whether each index was a risk factor for hematoma after the UBE lumbar fusion.Results The total hematoma incidence rate was 28.6%(30/105),the symptomatic hematoma rate was 6.7%(7/105),and the hematoma reoperation rate was 0.9%(1/105).Univariate logistic regression analysis showed that hypertension(OR=3.368,95%CI:1.389-8.171),diabetes(OR=3.589,95%CI:1.230-10.476),admission systolic blood pressure>140 mmHg(1 mmHg=0.133 kPa,OR=3.687,95%CI:1.493-9.017),platelets<200×10^(9)/L(OR=0.300,95%CI:0.119-0.785),preoperative blood calcium<2.25 mmol/L(OR=0.340,95%CI:0.142-0.818),spinal stenosis grade D(OR=4.462,95%CI:1.810-10.996)were possible risk factors for spinal hematoma after UBE lumbar fusion.Multivariate logistic regression analysis showed that admission blood pressure systolic blood pressure>140 mmHg(OR=3.788,95%CI:1.055-13.606),preoperative blood calcium<2.25 mmol/L(OR=78.544,95%CI:3.895-1584.058)and spinal stenosis grade D(OR=3.698,95%CI:1.110-12.325)were risk factors for spinal hematoma after UBE lumbar fusion(all P<0.05).Conclusion The types of spinal canal hematoma after UBE lumbar fusion include localized and extended type.The risk factors for hematoma include high systolic blood pr

关 键 词：腰椎 腰椎退变性疾病 单侧双通道内镜 椎管内血肿 并发症 相关因素 横断面研究 

分 类 号：R687.3[医药卫生—骨科学]