经皮椎间孔入路内镜下腰椎间盘切除术中类脊髓高压综合征发生的原因分析及预防措施  

Analysis of the causes of spinal cord hypertension-like syndrome and its preventive measures during percutaneous transforaminal endoscopic lumbar discectomy

作　　者：王琦琳 王越然 苟于炜 贾雨豪 谢贤松 张映波[1] WANG Qi-lin;WANG Yue-ran;GOU Yu-wei;JIA Yu-hao;XIE Xian-song;ZHANG Ying-bo(Department of Orthopedics,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan,673000,China)

机构地区：[1]川北医学院附属医院骨科,四川省637000

出　　处：《中国骨与关节杂志》2025年第1期27-33,共7页Chinese Journal of Bone and Joint

基　　金：白求恩专项科研基金项目(BK-JP2020001)。

摘　　要：目的探讨经皮椎间孔入路内镜下腰椎间盘切除术(percutaneous transforaminal endoscopic lumbar discectomy,PTELD)中类脊髓高压综合征发生的危险因素以及预防措施。方法回顾分析2019年8月至2023年8月于我院行局部麻醉下PTELD的腰椎间盘突出症患者的住院资料,根据是否发生PTELD术中并发症类脊髓高压综合征将患者分为并发症组(n=20)和对照组(n=422)。对水压高度、手术时间、是否发生硬脊膜破裂、椎间隙高度等相关临床指标进行单因素分析,初步筛选类脊髓高压综合征的危险因素,将单因素分析中具有统计学意义的自变量纳入二元Logistic回归进行多因素分析,研究类脊髓高压综合征的独立危险因素,最终通过受试者操作特征曲线(receiver operating characteristic curve,ROC)分析独立危险因素预测类脊髓高压综合征的能力。结果水压高度、手术时间、硬脊膜破裂与类脊髓高压综合征的发生风险呈显著正相关(P<0.05,OR>1),椎间隙高度与类脊髓高压综合征的发生风险呈显著负相关(P<0.05,OR<1)。以水压高度=94.25 cm,手术时间=59.55 min,椎间隙高度=7.55 mm为阈值预测类脊髓高压综合征的AUC均>0.50,联合模型预测的AUC大于单项独立危险因素。结论在保证手术安全和质量的前提下,尽量将灌洗液高度降低至94.25 cm以下,手术时间缩短至不超过59.55 min,同时避免硬脊膜破裂的发生,可有效降低类脊髓高压综合征的风险,提高患者术中的舒适度、耐受性、安全性以及手术的临床疗效。对于脊柱退变程度较重的患者,更应重视类脊髓高压综合征发生的可能。Objective To investigate the risk factors and preventive measures of spinal cord hypertension-like syndrome during percutaneous transforaminal endoscopic lumbar discectomy(PTELD).Methods We retrospectively analyzed the data of patients with lumbar disc herniation who underwent PTELD under local anesthesia in our hospital from August 2019 to August 2023.The patients were divided into the complication group(20 cases)and control group(422 cases)according to the occurrence of spinal cord hypertension-like syndrome during PTELD.The height of water pressure,operation time,dura mater rupture,intervertebral space and other related clinical indicators were recorded and compared between the two groups.The independent variables with statistical significance in univariate analysis were included in the binary Logistic regression analysis to study the independent influencing factors of spinal cord hypertension-like syndrome.Finally,the critical values of the independent influencing factors were determined by receiver operating characteristic(ROC)curve analysis to predict the risk of spinal cord hypertension-like syndrome.Results There was a significant positive correlation between the height of water pressure,operation time,dura mater rupture and the risk of spinal cord hypertension-like syndrome.The height of intervertebral space was negatively correlated with the risk of spinal cord hypertension-like syndrome.The highest sensitivity and specificity were obtained,while water pressure 94.25 cm,operation time 59.55 min and intervertebral space 7.55 mm as threshold values to predict the spinal cord hypertension-like syndrome respectively.The combined model had better clinical predictive value.Conclusions On the premise of ensuring the safety and quality of the operation,lower the height of irrigation fluid to less than 94.25 cm,shorten the operation time to less than 59.55 min,and avoid the rupture of dura mater can effectively reduce the risk of myeloid hypertension,improving the comfort,tolerance and safety of patients during

关 键 词：最小侵入性外科手术 椎间盘切除术 腰椎 类脊髓高压综合征 

分 类 号：R687.3[医药卫生—骨科学]