长节段腰椎固定融合术治疗退变性腰椎侧凸的并发症及危险因素分析
|
摘要
目的总结后路长节段腰椎固定融合术治疗退变性腰椎侧凸(degenerative lumbar scoliosis, DLS)的手术并发症,并分析其相关危险因素。方法选取2011年1月至2015年12月首都医科大学附属北京朝阳医院行后路长节段腰椎固定融合术的DLS患者54例,其中男18例,女36例。收集患者的相关数据,包括一般资料(性别、年龄、BMI)、基础合并症(高血压病、糖尿病、心脏疾病、脑血管病)、手术相关因素(术前Cobb角、手术时间、术中出血量、输血量、固定椎体数)以及相关并发症(早期、远期)。应用单因素分析和多因素logistic分析,确定并发症发生的相关危险因素。结果 54例患者中,15例(27.8%)出现并发症18例次,其中3例(5.6%)出现2种并发症,无死亡病例。伤口感染3例次(5.6%,深部2例次,表浅1例次);脑脊液漏3例次(5.6%);术后短暂下肢麻木或疼痛2例次(3.7%);硬膜外血肿1例次(1.9%);近端交界性后凸(proximal junctional kyphosis, PJK)6例次(11.1%),交界性失败(proximal junctional failure, PJF)再次手术2例次(3.7%);远端邻近节段退变(adjacent segment degeneration, ASD)2例次(3.7%),再次手术1例次(1.9%);内固定失败断棒1例次(1.9%)。单因素分析结果显示,两组年龄、性别、BMI、高血压、心脏疾病、脑血管病、术前Cobb角度数、输血量的差异无统计学意义(P>0.05)。多因素logistic回归分析显示,手术时间、固定椎体数是并发症发生的危险因素(OR=1.030,P=0.040;OR=2.343,P=0.018)。结论长节段腰椎固定融合术治疗DLS最常见的并发症是PJK、远端ASD;手术时间及固定椎体数是影响并发症发生的重要临床因素。
Objective To summarize the surgical complications of long segmental lumbar fusion for degenerative lumbar scoliosis(DLS), and to analyze the risk factors. Methods From January 2011 to December 2015, 54 patients with DLS received long segmental lumbar fusion were retrospectively investigated in Beijing Chaoyang Hospital. Clinical and surgical data were collected, including general data(age, gender, BMI), co-morbidity(hypertension, diabetes, heart disease, cerebrovascular disease), surgical related factors(Cobb angle, operation time, blood loss and transfusion, fusion segments) and early and late surgical complications. Univariate analysis and logistic regression equation were used to analyze the related risk factors for complication. Results The study consisted of 54 cases, including 18 males and 36 females. Fifteen cases(27.8%) had surgical complications, while there were 2 kinds of complications in 3 patients(5.6%), and no dead case. Wound infection occurred in 3 cases(5.6%), 2 cases of deep infection and 1 case of superficial infection.Cerebrospinal fluid leakage occurred in 3 cases(5.6%), postoperative transient numbness or pain occurred in 2 cases(3.7%), epidural hematoma occurred in 1 cases(1.9%), proximal junctional kyphosis(PJK) occurred in 6 cases(11.1%) and proximal junctional failure(PJF) occurred in 2 cases(3.7%), distal adjacent segment degeneration(ASD) occurred in 2 cases(3.7%), 1 case(1.9%) underwent reoperation, internal fixation failed in 1 cases(1.9%). There were no significant differences in age, gender, BMI, hypertension, heart disease,cerebrovascular disease, Cobb angle, blood transfusion between surgical complication group and no complication group. The multivariate logistic regression analysis showed that operation time, fusion segments were the risk factors to surgical complications(OR = 1.030, P = 0.040; OR = 2.343, P = 0.018). Conclusions The most common complications of long segmental lumbar fusion for DLS are proximal junctional kyphosis(PJK). Duration of operation and fusion segments are risk factors for the complication.
Objective To summarize the surgical complications of long segmental lumbar fusion for degenerative lumbar scoliosis(DLS), and to analyze the risk factors. Methods From January 2011 to December 2015, 54 patients with DLS received long segmental lumbar fusion were retrospectively investigated in Beijing Chaoyang Hospital. Clinical and surgical data were collected, including general data(age, gender, BMI), co-morbidity(hypertension, diabetes, heart disease, cerebrovascular disease), surgical related factors(Cobb angle, operation time, blood loss and transfusion, fusion segments) and early and late surgical complications. Univariate analysis and logistic regression equation were used to analyze the related risk factors for complication. Results The study consisted of 54 cases, including 18 males and 36 females. Fifteen cases(27.8%) had surgical complications, while there were 2 kinds of complications in 3 patients(5.6%), and no dead case. Wound infection occurred in 3 cases(5.6%), 2 cases of deep infection and 1 case of superficial infection.Cerebrospinal fluid leakage occurred in 3 cases(5.6%), postoperative transient numbness or pain occurred in 2 cases(3.7%), epidural hematoma occurred in 1 cases(1.9%), proximal junctional kyphosis(PJK) occurred in 6 cases(11.1%) and proximal junctional failure(PJF) occurred in 2 cases(3.7%), distal adjacent segment degeneration(ASD) occurred in 2 cases(3.7%), 1 case(1.9%) underwent reoperation, internal fixation failed in 1 cases(1.9%). There were no significant differences in age, gender, BMI, hypertension, heart disease,cerebrovascular disease, Cobb angle, blood transfusion between surgical complication group and no complication group. The multivariate logistic regression analysis showed that operation time, fusion segments were the risk factors to surgical complications(OR = 1.030, P = 0.040; OR = 2.343, P = 0.018). Conclusions The most common complications of long segmental lumbar fusion for DLS are proximal junctional kyphosis(PJK). Duration of operation and fusion segments are risk factors for the complication.
引文
[1]Russo A,Bransford R,Wagner T,et al.Adult degenerative scoliosis insights,challenges,and treatment outlook[J].Curr Orthop Prac,2008,19:357-365.
[2]Aebi M.The adult scoliosis[J].Eur Spine J,2005,14:925-948.
[3]Tribus CB.Degenerative lumbar scoliosis:evaluation and management[J].J Am Acad Orthop surg,2003,11:174-183.
[4]海涌,孟祥龙,鲁世宝,等.退变性腰椎侧凸长节段固定融合的手术治疗[J].中国骨科临床与基础研究杂志,2013,5:200-206.
[5]Transfeldt EE,Topp R,Mehbod AA,et al.Surgical outcomes of decompression,decompression with limited fusion,and decompression with full curve fusion for degenerative scoliosis with radiculopathy[J].Spine(Phila Pa 1976),2010,35:1872-1875.
[6]Kleinstueck FS,Fekete TF,Jeszenszky D,et al.Adult degenerative scoliosis:comparison of patient-rated outcome after three different surgical treatments[J].Eur Spine J,2016,25:2649-2656.
[7]Wimmer C,Gluch H.Management of postoperative wound infection in posterior spinal fusion with instrumentation[J].J Spinal Disord,1996,9:505-508.
[8]Rohmiller MT,Akbarnia BA,RaiszadehK,et al.Closed suction irrigation for the treatment of postoperative wound infections following posterior spinal fusion and instrumentation[J].Spine(Phila Pa 1976),2010,35:642-646.
[9]Smith JS,Shaffrey CI,Sansur CA,et al.Rates of infection after spine surgery based on 108,419 procedures:a report from the Scoliosis Research Society Morbidity and Mortality Committee[J].Spine(Phila Pa1976),2011,36:556-563.
[10]Stromqvist F,Jonsson B,Strmmqvist B.Dural lesions in lumbar disc hemiation surgery:incidence,risk factors,and outcome[J].Eur Spine J,2010,19:439-442.
[11]Stromqvist F,Jonsson B,Stromnlqvist B.Dural lesions in decompression for lumbar spinal stenosis:incidence,risk factors and effect on outcome[J].Eur Spine J,2012,21:825-828.
[12]张志平,郭昭庆,孙垂国,等.退变性腰椎疾患后路减压术后脑脊液漏的相关因素分析及处理[J].中国脊柱脊髓杂志,2014,24:906-911.
[13]Govind J.Lumbar radicular pain[J].Aust Fam Physician,2004,33:409-412.
[14]Kou J,Fischgrund J,Biddinger A,et al.Risk factors for spinal epidural hematoma after spinal surgery[J].Spine(Phila Pa 1976),2002,27:1670-1673.
[15]Greon RJM,Ponssen H.The spontaneous spinal epidural hematoma:a study of etiology[J].J Neurol Sci,1990,98:121-138.
[16]Nguyen NL,Kong CY,Hart RA,et al.Proximal junctional kyphosis and failure diagnosis,prevention and treatment[J].Curr Rev musculoskelet Med,2016,9:299-308.
[17]Kim HJ,Lenke LG,Shaffrey CI,et al.Pmximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery:a systematic review[J].Spine,2012,37:S144-S164.
[18]Hart R,McCarthy I,O'Brien M,et al.Identification of decision criteria for revision surgery among patients with proximal junctional failure after surgical treatment of spinal deformity[J].Spine(Phila Pa1976),2013,38:E1223-E1227.
[19]Yagi M,Rahm M,Gaines R,et al.Characterization an surgical outcomes of proximal junctional failure in surgically treated patients with adult spinal deformity[J].Spine(Phila Pa 1976),2014,39:E607-E614.
[20]Kim HJ,Bridwell KH,Lenke LG,et al.Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections[J].Spine(Phila Pa 1976),2014,39:E576-E580.
[21]Goto K,Tajima N,Chosa E,et al.Effects of lumbar spinal fusion on the other lumhar intervertebral levels(three-dimensional finite element analysis)[J].J Orthop Sci,2003,8:577-584.
[22]Edwards CC 2nd,Bridwell KH,Patel A,et al.Long adult deformity fusions to L5 and the sacrum.A matched cohort analysis[J].Spine(Phila Pa 1976),2004,29:1996-2005.
[23]Lee CS,Hwang CJ,Lee SW,et al.Risk factors for adjacent segment disease after lumbar fusion[J].Eur Spine J,2009,18:1637-1643.
[24]Kumar MN,Baklanov A,Chopin D.Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion[J].Eur Spine J,2001,10:314-319.
[25]Smith JS,Shaffrey E,Klineberg E,et al.Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity[J].J Neurosurg Spine,2014,21:994-1003.
[26]Smith JS,Shaffrey CI,Ames CP,et al.Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity[J].Neurosurgery,2012,71:862-867.
[27]Aizawa T,Ozawa H,Kusakabe T,et al.Reoperation for recurrent lumbar disc herniation:a study over a 20 year period in a Japanese population[J].J Orthop Sci,2012,17:107-113.
[2]Aebi M.The adult scoliosis[J].Eur Spine J,2005,14:925-948.
[3]Tribus CB.Degenerative lumbar scoliosis:evaluation and management[J].J Am Acad Orthop surg,2003,11:174-183.
[4]海涌,孟祥龙,鲁世宝,等.退变性腰椎侧凸长节段固定融合的手术治疗[J].中国骨科临床与基础研究杂志,2013,5:200-206.
[5]Transfeldt EE,Topp R,Mehbod AA,et al.Surgical outcomes of decompression,decompression with limited fusion,and decompression with full curve fusion for degenerative scoliosis with radiculopathy[J].Spine(Phila Pa 1976),2010,35:1872-1875.
[6]Kleinstueck FS,Fekete TF,Jeszenszky D,et al.Adult degenerative scoliosis:comparison of patient-rated outcome after three different surgical treatments[J].Eur Spine J,2016,25:2649-2656.
[7]Wimmer C,Gluch H.Management of postoperative wound infection in posterior spinal fusion with instrumentation[J].J Spinal Disord,1996,9:505-508.
[8]Rohmiller MT,Akbarnia BA,RaiszadehK,et al.Closed suction irrigation for the treatment of postoperative wound infections following posterior spinal fusion and instrumentation[J].Spine(Phila Pa 1976),2010,35:642-646.
[9]Smith JS,Shaffrey CI,Sansur CA,et al.Rates of infection after spine surgery based on 108,419 procedures:a report from the Scoliosis Research Society Morbidity and Mortality Committee[J].Spine(Phila Pa1976),2011,36:556-563.
[10]Stromqvist F,Jonsson B,Strmmqvist B.Dural lesions in lumbar disc hemiation surgery:incidence,risk factors,and outcome[J].Eur Spine J,2010,19:439-442.
[11]Stromqvist F,Jonsson B,Stromnlqvist B.Dural lesions in decompression for lumbar spinal stenosis:incidence,risk factors and effect on outcome[J].Eur Spine J,2012,21:825-828.
[12]张志平,郭昭庆,孙垂国,等.退变性腰椎疾患后路减压术后脑脊液漏的相关因素分析及处理[J].中国脊柱脊髓杂志,2014,24:906-911.
[13]Govind J.Lumbar radicular pain[J].Aust Fam Physician,2004,33:409-412.
[14]Kou J,Fischgrund J,Biddinger A,et al.Risk factors for spinal epidural hematoma after spinal surgery[J].Spine(Phila Pa 1976),2002,27:1670-1673.
[15]Greon RJM,Ponssen H.The spontaneous spinal epidural hematoma:a study of etiology[J].J Neurol Sci,1990,98:121-138.
[16]Nguyen NL,Kong CY,Hart RA,et al.Proximal junctional kyphosis and failure diagnosis,prevention and treatment[J].Curr Rev musculoskelet Med,2016,9:299-308.
[17]Kim HJ,Lenke LG,Shaffrey CI,et al.Pmximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery:a systematic review[J].Spine,2012,37:S144-S164.
[18]Hart R,McCarthy I,O'Brien M,et al.Identification of decision criteria for revision surgery among patients with proximal junctional failure after surgical treatment of spinal deformity[J].Spine(Phila Pa1976),2013,38:E1223-E1227.
[19]Yagi M,Rahm M,Gaines R,et al.Characterization an surgical outcomes of proximal junctional failure in surgically treated patients with adult spinal deformity[J].Spine(Phila Pa 1976),2014,39:E607-E614.
[20]Kim HJ,Bridwell KH,Lenke LG,et al.Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections[J].Spine(Phila Pa 1976),2014,39:E576-E580.
[21]Goto K,Tajima N,Chosa E,et al.Effects of lumbar spinal fusion on the other lumhar intervertebral levels(three-dimensional finite element analysis)[J].J Orthop Sci,2003,8:577-584.
[22]Edwards CC 2nd,Bridwell KH,Patel A,et al.Long adult deformity fusions to L5 and the sacrum.A matched cohort analysis[J].Spine(Phila Pa 1976),2004,29:1996-2005.
[23]Lee CS,Hwang CJ,Lee SW,et al.Risk factors for adjacent segment disease after lumbar fusion[J].Eur Spine J,2009,18:1637-1643.
[24]Kumar MN,Baklanov A,Chopin D.Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion[J].Eur Spine J,2001,10:314-319.
[25]Smith JS,Shaffrey E,Klineberg E,et al.Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity[J].J Neurosurg Spine,2014,21:994-1003.
[26]Smith JS,Shaffrey CI,Ames CP,et al.Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity[J].Neurosurgery,2012,71:862-867.
[27]Aizawa T,Ozawa H,Kusakabe T,et al.Reoperation for recurrent lumbar disc herniation:a study over a 20 year period in a Japanese population[J].J Orthop Sci,2012,17:107-113.