胸椎黄韧带骨化症术后脑脊液漏的相关因素  

Factors related to cerebrospinal fluid leakage in posterior decompression of thoracic ossification of ligamentum flaum

作　　者：杨帆 宋扬 钱澍 魏飞龙 朱凯龙 钱济先 周程沛 YANG Fan;SONG Yang;QIAN Shu;WEI Fei-long;ZHU Kai-long;QIAN Ji-xian;ZHOU Cheng-pei(Department of Orthopedics The Second Affiliated Hospital,Air Force Military Medical University,Xi'an 710038 China)

机构地区：[1]空军军医大学第二附属医院骨科,陕西西安710038

出　　处：《中国矫形外科杂志》2023年第9期781-786,共6页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81871818)。

摘　　要：[目的]探索后路全椎板切除术治疗胸椎黄韧带骨化症脑脊液漏(leakage of cerebrospinal fluid,CSFL)的发生率和相关因素,为临床预防提供依据。[方法]采用回顾性队列研究方法,分析2015年8月-2021年8月诊断为胸椎黄韧带骨化症并行后路全椎板切除术治疗患者的临床资料,根据术后是否并发脑脊液漏分为CSFL组和无CSFL组,采用单项因素比较及二元多因素逻辑分析CSFL的相关因素。[结果]共108例患者纳入本研究,28例并发CSFL,发生率为25.9%。单项因素比较表明:与无CSFL组相比,CSFL组术前双下肢瘫痪比率显著高(P<0.05);影像上椎管面积残余率、正中线前后径残余率、矢状位前后径残余率均显著小(P<0.05);此外,术中采用传统骨凿比率显著高(P<0.05),手术节段数显著多(P<0.05),手术时间和住院时间显著长(P<0.05)。但是,两组年龄、性别、BMI、病程、二便功能障碍、术前mJOA、饮酒史、吸烟史、术前合并症(高血压、糖尿病)、Sato分型、MRI分型、侧界前后径残余率、旁正中前后径残余率及手术部位的差异均无统计学意义(P>0.05)。逻辑回归表明:手术节段多(OR=4.272,P=0.007)、椎管面积残余率小(OR=0.903,P<0.001)是CSFL发生的独立危险因素。[结论]手术节段多、椎管面积残余率低的患者发生CSFL的风险增高,应采取针对性的措施,以减少CSFL的发生。[Objective]To explore the incidence and related factors of cerebrospinal fluid leakage(CSFL)in posterior total laminectomy for decompression of thoracic ossification ligamentum flavum to provide a reference for clinical prevention of CSFL.[Methods]A retrospective cohort study was conducted on patients who received posterior total laminectomy for decompression of thoracic ossification of ligamentum flavum between August 2015 and August 2021.According to whether CSFL happened,the patients were divided into the CSFL group and non-CSFL group.The univariate comparison,and multiple binary logic regression were conducted to search the factors related to CSFL.[Results]Of the 108 patients included in this study,28 patients had CSFL,accounting for 25.93%.In term of univariate comparison,the CSFL group had significantly higher ratio of preoperative limb paralysis(P<0.05);significantly less residual rate of spinal canal area,the residual rate of diameter of the canal on the midline and the residual rate of the sagittal diameter on the images(P<0.05);additionally,significantly higher ratio of intraoperative conventional bone chisels used(P<0.05),significantly more number of segments involved(P<0.05),as well as significantly longer operation time and hospital stay than the non-CSFL group(P<0.05).However,there were no significant differences between the two groups in age,gender,BMI,course of disease,bladder and bowel dysfunction,preoperative JOA score,drinking history,smoking history,preoperative comorbidities,such as hypertension,diabetes,Sato classification,MRI grade,residual rate of transverse and anteroposterior diameter,residual rate of paramedian diameter and surgical site(P>0.05).As result of logistic regression,the more segments involved(OR=4.272,P=0.007)and small residual rate of spinal canal area(OR=0.903,P<0.001)was an independent risk factor for CSFL.[Conclusion]More thoracic segments involved and less residual rate of spinal canal area are associated with higher risk of CSFL.The corresponding measures should be tak

关 键 词：胸椎 黄韧带骨化症 脑脊液漏 危险因素 

分 类 号：R686.5[医药卫生—骨科学]