脊柱侧凸畸形行全脊椎截骨术后大量引流情况及危险因素分析
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摘要
目的研究脊柱侧凸畸形行全脊椎截骨术后大量引流情况,并分析其危险因素。方法纳入2013-08-2018-01,于我院采用全脊椎截骨术治疗的145例脊柱侧凸畸形患者,根据术后引流量/估计血容量比例,将≤30%者设为正常引流量组,>30%者设为大量引流量组。统计两组患者术前Cobb角、手术节段、年龄、性别等病历资料,经单因素与多因素分析,调查脊柱侧凸畸形全脊椎截骨术后大量引流的独立危险因素。结果 145例患者术后出现大量引流56例,发生率38.62%,平均引流量(1037.34±148.34)ml;正常引流量组平均引流量(632.24±108.21)ml。组间术前Cobb角、手术节段、术前血小板计数(PLT)、术中输血量、身体质量指数(Body Mass Index, BMI)、术前美国麻醉医师协会(ASA)分级、畸形类型、置钉数、手术时间差异有统计学意义(P<0.05),性别、年龄、住院时间、术后输血差异无统计学意义(P>0.05);多因素Logistic回归分析显示,术前Cobb角≥55°(OR=3.657,95%CI:1.154～12.432)、手术节段>10(OR=3.256,95%CI:1.128～11.213)、术前PLT<190×109/L(OR=3.041,95%CI:1.231～10.082)、术中输血≥19.55 ml/kg(OR=2.976,95%CI:1.215～9.656)是脊柱侧凸畸形全脊椎截骨术后大量引流的独立危险因素。结论脊柱侧凸畸形全脊椎截骨术后容易出现大量引流情况,术前Cobb角≥55°、手术节段>10、术前PLT<190×109/L、术中输血≥19.55 ml/kg均会增加其发生风险。
Objective To study the situation of massive drainage after total vertebral osteotomy in the treatment of scoliosis deformity and analyze the risk factors. Methods A total of 145 patients with scoliosis who underwent total vertebroplasty in our hospital from August 2013 to January 2018 were enrolled in this study. According to postoperative drainage/estimated blood volume ≤30% and > 30%, they were set as the normal drainage group and the large drainage group. The preoperative Cobb angle, surgical segment, age, gender and other medical records were collected from the two groups. The single-factor and multi-factor analysis was used to investigate the independent risk factors of a large number of drainage after total vertebral osteotomy in the treatment of scoliosis deformity. Results A total of 145 patients had a large number of drainage after operation in 56 cases, the incidence rate was 38.62%,the mean drainage volume(1037.34±148.34) ml, the average drainage volume of the normal drainage group(632.24±108.21) ml; the preoperative Cobb angle between the groups, the surgical segment Preoperative platelet count(PLT), intraoperative blood transfusion,body mass index(BMI), preoperative American Society of Anesthesiologists(ASA) classification, type of deformity, number of nails, and time difference were statistically significant(P <0.05), there was no significant difference in gender, age, hospitalization time and postoperative blood transfusion(P >0.05). Multivariate logistic regression analysis showed preoperative Cobb angle ≥55°(OR =3.657,95%CI:1.154～12.432), surgical segment >10(OR=3.256,95%CI:1.128～11.213), preoperative PLT<190×109/L(OR=3.041,95%CI:1.231～10.082), intraoperative blood transfusion ≥19.55 ml/kg(OR=2.976, 95%CI:1.215～9.656) were the independent risk factor for massive drainage after total vertebral osteotomy. Conclusion Spine scoliosis is prone to a large number of drainage after total vertebroplasty. Preoperative Cobb angle ≥55°, surgical segment >10, preoperative PLT<190×109/L, intraoperative blood transfusion ≥19.55 ml/kg can increase its risk.
Objective To study the situation of massive drainage after total vertebral osteotomy in the treatment of scoliosis deformity and analyze the risk factors. Methods A total of 145 patients with scoliosis who underwent total vertebroplasty in our hospital from August 2013 to January 2018 were enrolled in this study. According to postoperative drainage/estimated blood volume ≤30% and > 30%, they were set as the normal drainage group and the large drainage group. The preoperative Cobb angle, surgical segment, age, gender and other medical records were collected from the two groups. The single-factor and multi-factor analysis was used to investigate the independent risk factors of a large number of drainage after total vertebral osteotomy in the treatment of scoliosis deformity. Results A total of 145 patients had a large number of drainage after operation in 56 cases, the incidence rate was 38.62%,the mean drainage volume(1037.34±148.34) ml, the average drainage volume of the normal drainage group(632.24±108.21) ml; the preoperative Cobb angle between the groups, the surgical segment Preoperative platelet count(PLT), intraoperative blood transfusion,body mass index(BMI), preoperative American Society of Anesthesiologists(ASA) classification, type of deformity, number of nails, and time difference were statistically significant(P <0.05), there was no significant difference in gender, age, hospitalization time and postoperative blood transfusion(P >0.05). Multivariate logistic regression analysis showed preoperative Cobb angle ≥55°(OR =3.657,95%CI:1.154～12.432), surgical segment >10(OR=3.256,95%CI:1.128～11.213), preoperative PLT<190×109/L(OR=3.041,95%CI:1.231～10.082), intraoperative blood transfusion ≥19.55 ml/kg(OR=2.976, 95%CI:1.215～9.656) were the independent risk factor for massive drainage after total vertebral osteotomy. Conclusion Spine scoliosis is prone to a large number of drainage after total vertebroplasty. Preoperative Cobb angle ≥55°, surgical segment >10, preoperative PLT<190×109/L, intraoperative blood transfusion ≥19.55 ml/kg can increase its risk.
引文
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[2] Schaverien MV, Moeller JA, Cleveland SD.Nonoperative Treatment of Lymphedema[J]. Seminars in Plastic Surgery, 2018, 32(01):017-021.
[3] Zhang JX, Jing XW, Cui P, et al. Effectiveness of dynamic fixation Coflex treatment for degenerative lumbar spinal stenosis[J].Experimental&Therapeutic Medicine, 2018, 15(1):667-672.
[4]王东海,邢文华,祝勇,等.脊柱术后早期分层预防静脉血栓栓塞症的疗效分析[J].脊柱外科杂志, 2017, 15(4):227-232.
[5]奉国成,王均,陆维,等.氨甲环酸结合术后引流管夹闭在脊柱侧凸矫形术中的应用[J].西南国防医药, 2017, 27(8):794-796.
[6] Bozkurt G,Yaman ME.Subarachnoid Hemorrhage Presenting with Seizure due to Cerebrospinal Fluid Leakage after Spinal Surgery[J].J Korean Neurosurg Soc, 2016, 59(1):62-64.
[7] Zou DX, Zhou JL, Zhou XX, et al.Clinical efficacy of CT-guided percutaneous huge ilio-psoas abscesses drainage combined with posterior approach surgery for the management of dorsal and lumbar spinal tuberculosis in adults[J]. Orthop Traumatol Surg Res,2017, 103(8):1251-1255.
[8] Sahutoglu C, Pestilci Z, Kocabas S, et al. Epidural Catheter Placement for Cerebrospinal Fluid Drainage in Aortic Aneurysm Surgery With Delayed Paraplegia:A Case Report[J]. Journal of Medical Cases, 2016, 8(1):1-4.
[9]李娜,贾锐,顾小萍,等.青少年脊柱侧凸后路矫形术术后大量引流的危险因素分析[J].中华医学杂志, 2017, 97(44):3460-3465.
[10] Kashiwa K,Ono F,Kimura Y, et al. A case of pseudohypoxic brain swelling after lumbar spinal surgery[J]. Nihon Shuchu Chiryo Igakukai Zasshi, 2016, 23(4):385-388.