经椎间孔腰椎椎间融合术治疗腰椎退行性疾病术后引流量增加的危险因素分析  

Analysis of Risk Factors for Increased Drain Output After Transforaminal Lumbar Interbody Fusion in Patients with Lumbar Degenerative Diseases

作　　者：杨磊[1] 程乐 陈永康 孙超 熊承杰 魏坦军 陈胤 徐峰 ANG Lei;CHENG Le;CHEN Yongkang;SUN Chao;XIONG Chengjie;WEI Tanjun;CHEN Ying;XU Feng(Faculty of Medicine School of Medicine,Wuhan University of Science and Technology,Wuhan Hubei 430081,China)

机构地区：[1]武汉科技大学医学部医学院,湖北武汉430065 [2]中部战区总医院骨科

出　　处：《联勤军事医学》2024年第10期837-842,共6页Military Medicine of Joint Logistics

基　　金：湖北省自然科学基金青年项目(2022CFB878)。

摘　　要：目的分析经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎退行性疾病术后引流量增加的危险因素。方法选取2020-01/2022-12月因腰椎退行性疾病在作者医院就诊、接受经TLIF且术后引流量数据记载详细的65例患者进行回顾性研究。根据总引流量进行分组,分为引流量正常组(n=32)与引流量增加组(n=33)。比较两组患者的一般资料,通过单因素分析和多因素Logistic回归分析确定两组患者TLIF后引流量增加的危险因素,通过受试者工作特征(receiver operating characteristic,ROC)曲线分析相关危险因素的预测价值。结果引流量增加组患者的年龄、并发症的比例、手术时间、失血量、术前D-二聚体水平、术后第1天引流量均明显大于引流量正常组,而术前血红蛋白、术后白蛋白、术前白细胞计数和术后血小板计数明显低于引流量正常组,差异具有统计学意义(P均<0.05)。Logistic回归分析显示,术中失血量和术后第1天引流量是TLIF术后引流量增加的独立危险因素(P<0.05)。ROC曲线分析结果显示,术前血红蛋白、失血量、术后第1天引流量联合预测模型的曲线下面积(area under the curve,AUC)为0.937,灵敏度为0.818,特异度为0.906,临界值为0.59,联合模型预测腰椎退行性疾病患者TLIF后引流量增加的AUC高于任何单一因素。结论术中失血量、术后第1天引流量是TLIF术后引流量增加的独立危险因素,术前血红蛋白可能是引流量增加的保护因素。联合失血量、术后第1天引流量和术前血红蛋白的回归模型对腰椎退行性疾病患者TLIF后引流量增加的预测价值较高。Objective To analyze the risk factors for increased drain output after transforaminal lumbar interbody fusion(TLIF)in patients with lumbar degenerative diseases.Methods 65 patients with lumbar degenerative diseases who underwent TLIF in author′s hospital and had detailed drainage data from January 2020 to December 2022 were selected for retrospective study.Patients were divided into normal group(n=32)and increased group(n=33)based on the total drainage volume.The general data of the two groups were compared,and the risk factors of increased drainage flow after TLIF were determined by univariate analysis and multivariate Logistic regression analysis,the predictive value of relevant risk factors was analyzed by receiver operating characteristic(ROC)curves.Results The age,proportion of complications,operation time,blood loss volume,preoperative D-dimer level and postoperative 1st day of drainage flow in the increased group were significantly higher than those in the normal group,while the levels of preoperative hemoglobin,postoperative albumin,preoperative white blood cell count and preoperative platelets were significantly lower than those in the normal group,the difference was statistically significant(all P<0.05).Logistic regression analysis showed that intraoperative blood loss and 1st day drainage volume were independent risk factors for increased drainage volume after TLIF(P<0.05).The ROC curve analysis results showed that the area under the curve(AUC)of the combined prediction model of preoperative hemoglobin,blood loss and drainage flow on the 1st day after surgery was 0.937,the sensitivity was 0.818,the specificity was 0.906,and the critical value was 0.59,the combined model predicted that the AUC of increased drainage volume after TLIF in patients with lumbar degenerative disease was higher than any single factor.Conclusion Intraoperative blood loss and postoperative drainage volume on the 1st day are independent risk factors for increased drainage volume after TLIF,and preoperative hemoglobin may be a p

关 键 词：引流量 失血量 腰椎退行性疾病 危险因素 经椎间孔腰椎椎间融合术 

分 类 号：R681.57[医药卫生—骨科学]