颈椎手术并发脑脊液漏的危险因素Logistic回归分析
|
摘要
目的探讨颈椎手术中并发脑脊液漏的相关因素,为临床提供一定的参考。方法本研究收集了我院骨科自2010-02-2016-02开展的颈椎手术患者310例,其中发生脑脊液漏19例,现统计其性别、体重肥胖指数、吸烟和饮酒史、内科合并症(糖尿病和高血压)、病程、骨折与否、局部病变类型(椎间盘突出、颈椎管狭窄、后纵韧带骨化或骨质增生、黄韧带肥厚、硬脊膜粘连),手术入路和手术节段等可能的相关因素,并进行组间单因素分析和多因素Logistic回归分析。结果单因素分析显示,骨折、颈椎管狭窄、硬膜粘连和后纵韧带骨化有显著的组间差异(P<0.05);多因素Logistic回归分析显示,上述四项均为独立的危险因素之一。结论骨折、后纵韧带骨化、颈椎管狭窄和硬脊膜粘连均为颈椎手术并发脑脊液漏的独立危险因素,应予以重视。
Objective To investigate the related factors of cerebrospinal fluid leakage during cervical spine surgery, so as to provide a reference for clinical practice. Methods From February2010 to February 2016, 310 patients with cervical spine surgery in our hospital were collected in this study. And 19 cases occurred cerebrospinal fluid leakage. The gender, body mass index, smoking and drinking history, medical comorbidities(diabetes and hypertension), course of disease, bone fracture and local lesion type(disc herniation, spinal stenosis, ossification of the posterior longitudinal ligament and bone hyperplasia, yellow ligament hypertrophy, dural adhesions), related factors of surgical approach and surgical segment were analyzed, and Logistic regression analysis of single factor and multi factor between two groups was performed. Results Univariate analysis showed that the fracture and cervical spinal stenosis, dura adhesion and ossification of the posterior longitudinal ligament had significant differences between the two groups(P<0.05). Logistic regression analysis showed that these four indicators were independent risk factors. Conclusion Fracture, posterior longitudinal ligament ossification, cervical spinal stenosis and dura mater adhesion are the independent risk factors of cerebrospinal fluid leakage in cervical spine surgery, and should be paid attention to in the actual operation.
Objective To investigate the related factors of cerebrospinal fluid leakage during cervical spine surgery, so as to provide a reference for clinical practice. Methods From February2010 to February 2016, 310 patients with cervical spine surgery in our hospital were collected in this study. And 19 cases occurred cerebrospinal fluid leakage. The gender, body mass index, smoking and drinking history, medical comorbidities(diabetes and hypertension), course of disease, bone fracture and local lesion type(disc herniation, spinal stenosis, ossification of the posterior longitudinal ligament and bone hyperplasia, yellow ligament hypertrophy, dural adhesions), related factors of surgical approach and surgical segment were analyzed, and Logistic regression analysis of single factor and multi factor between two groups was performed. Results Univariate analysis showed that the fracture and cervical spinal stenosis, dura adhesion and ossification of the posterior longitudinal ligament had significant differences between the two groups(P<0.05). Logistic regression analysis showed that these four indicators were independent risk factors. Conclusion Fracture, posterior longitudinal ligament ossification, cervical spinal stenosis and dura mater adhesion are the independent risk factors of cerebrospinal fluid leakage in cervical spine surgery, and should be paid attention to in the actual operation.
引文
[1]马良,盛伟斌,邓强,等.颈椎术后脑脊液漏治疗:不同引流方法比较[J].中国组织工程研究,2013,(48):8413-8418.
[2]崔华民,杨利军,赵彬,等.创伤性脑脊液漏的诊断和治疗[J].河北医药,2014,(2):269-270.
[3]Nandyala SV,Elboghdady IM,Marquezlara A,et al.Cost analysis of incidental durotomy in spine surgery[J].Spine,2014,39(17):1042-1051.
[4]Fengbin Y,Xinyuan L,Xiaowei L,et al.Management and outcomes of cerebrospinal fluid leak associated with anterior decompression for cervical ossification of the posterior longitudinal ligament with or without dural ossification[J].J Spinal Disord Tech,2015,28(11):1664-1668.
[5]陈捷,汪光晔,黄文俊,等.胸椎退行性病变减压术后脑脊液漏危险因素分析及护理研究[J].护士进修杂志,2017,32(7):597-600.
[6]唐六一,胡豇,张耀明,等.脊柱手术并发脑脊液漏的原因和治疗方式[J].实用医院临床杂志,2008,5(5):67-68.
[7]Lee SE,Chung CK,Jahng TA,et al.Dural tear and resultant cerebrospinal fluid leaks after cervical spinal trauma[J].Eur Spine J,2014,23(8):1772-1776.
[8]王占国.术区持续引流至切口愈合时拔管缝合管口治疗脊柱骨折伴硬脊膜损伤术后脑脊液漏研究[J].实用手外科杂志,2017,31(1):88-90,94.
[9]任大江,张兴胜,张志成,等.老年腰椎管狭窄症患者术中硬膜囊撕裂位置的分析[J].解放军医药杂志,2014,(10):9-11.
[2]崔华民,杨利军,赵彬,等.创伤性脑脊液漏的诊断和治疗[J].河北医药,2014,(2):269-270.
[3]Nandyala SV,Elboghdady IM,Marquezlara A,et al.Cost analysis of incidental durotomy in spine surgery[J].Spine,2014,39(17):1042-1051.
[4]Fengbin Y,Xinyuan L,Xiaowei L,et al.Management and outcomes of cerebrospinal fluid leak associated with anterior decompression for cervical ossification of the posterior longitudinal ligament with or without dural ossification[J].J Spinal Disord Tech,2015,28(11):1664-1668.
[5]陈捷,汪光晔,黄文俊,等.胸椎退行性病变减压术后脑脊液漏危险因素分析及护理研究[J].护士进修杂志,2017,32(7):597-600.
[6]唐六一,胡豇,张耀明,等.脊柱手术并发脑脊液漏的原因和治疗方式[J].实用医院临床杂志,2008,5(5):67-68.
[7]Lee SE,Chung CK,Jahng TA,et al.Dural tear and resultant cerebrospinal fluid leaks after cervical spinal trauma[J].Eur Spine J,2014,23(8):1772-1776.
[8]王占国.术区持续引流至切口愈合时拔管缝合管口治疗脊柱骨折伴硬脊膜损伤术后脑脊液漏研究[J].实用手外科杂志,2017,31(1):88-90,94.
[9]任大江,张兴胜,张志成,等.老年腰椎管狭窄症患者术中硬膜囊撕裂位置的分析[J].解放军医药杂志,2014,(10):9-11.