| 张心灵,袁 磊,曾 岩,陈仲强,李危石,孙垂国,杜国红.退变性腰椎侧凸后路长节段固定融合术中大量失血的相关危险因素分析[J].中国脊柱脊髓杂志,2019,(5):414-421. |
| 退变性腰椎侧凸后路长节段固定融合术中大量失血的相关危险因素分析 |
| 中文关键词: 退变性腰椎侧凸 长节段固定融合 术中大量失血 危险因素 |
| 中文摘要: |
| 【摘要】 目的：探讨退变性腰椎侧凸（degenerative lumbar scoliosis，DLS）后路长节段固定融合术中大量失血的相关危险因素。方法：收集173例在我院行后路长节段（≥4节段）固定融合术的DLS患者的临床资料，根据术中失血量分为大量失血组（失血分数≥30%）和非大量失血组（失血分数<30%）。比较两组患者术前、术中及术后相关资料，患者人口学资料包括性别、年龄、体重指数（body mass index, BMI）、吸烟史、饮酒史、术前骨质状况、术前美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级等；影像学资料包括术前Cobb角、冠状面和矢状面失衡情况、顶椎偏移距离（apical vertebral translation，AVT）、腰椎前凸角（lumbar lordosis，LL）、Cobb角和LL矫正值；手术相关资料包括手术时间、固定节段、减压节段、椎间融合节段、术中截骨及截骨级别、固定骶骨、术中使用氨甲环酸（tranexamic acid，TXA）情况等、术中失血量、术中及术后输血资料和医疗费用。采用单因素分析及多因素Logistics回归分析导致术中大量失血的危险因素。结果：67例患者纳入大量失血组，106例患者纳入非大量失血组，单因素分析结果显示大量失血组相较非大量失血组，BMI较小（P=0.046）、术前Cobb角较大（P<0.001）、AVT较大（P=0.002）、Cobb角矫正值（P<0.001）较大、固定节段较多（P<0.001）、椎间融合节段较多（P=0.043）、截骨级别较高（P<0.001）、术中TXA使用比例更小（P=0.046），大量失血组在围手术期输血量（P=0.015）、输血率（P=0.035）、术后住院时间（P=0.035）、住院费用（P=0.023）显著高于非大量失血组。多因素Logistics二元回归分析结果显示BMI每增加1kg/m2，术中大量失血风险降低9.3%；术中Cobb角矫正值每增加1°、固定节段每增加1个节段，术中大量失血风险分别增加5.9%、58.9%；椎间融合节段每增加一个节段，术中大量失血风险增加1.174倍；术中行三级及以上截骨使术中大量失血风险增加9.262倍；术中使用TXA使术中大量失血风险降低71.2%。结论：BMI较小，术前Cobb角和AVT较大，Cobb角矫正值增加、固定节段增加、椎间融合节段增加、术中截骨、截骨分级高、术中未使用TXA等因素是导致DLS患者长节段固定融合手术术中大量失血的潜在危险因素，其中，BMI较小、Cobb角矫正值增加、固定节段增加、椎间融合节段增加、行3级及以上截骨、术中未使用TXA是导致术中大量失血的独立危险因素。 |
Risk factors of massive blood loss during posterior long-level instrumentation surgery in degenerative lumbar scoliosis |
| 英文关键词:Degenerative lumbar scoliosis Long levels fusion Massive blood loss Risk factors |
| 英文摘要: |
| 【Abstract】 Objectives: To investigate the risk factors of massive blood loss during posterior long-level instrumentation in degenerative lumbar scoliosis(DLS). Methods: The study retrospectively included 173 patients with DLS who underwent long-segmental segmentation(≥4 levels). They were divided into two groups according to the intraoperative blood loss, massive blood loss group (proportion of blood loss ≥30%) and non-large blood loss group(proportion of blood loss <30%). The data of the two groups before, during and after operation were compared, including gender, age, body mass index(BMI), smoking, drinking status, preoperative bone quality, preoperative American Society of Anesthesiologists(ASA), preoperative Cobb angle, coronal vertical axis(CVA) and sagittal vertical axis(SVA) imbalance, apical vertebral translation(AVT), lumbar lordosis(LL), Cobb and LL change, operation time, fusion levels, decompression levels, intervertebral fusion segments, intraoperative osteotomy and osteotomy level, sacrum fixation, tranexamic acid(TXA) usage, intraoperative blood loss, intraoperative and postoperative blood transfusion, medical expenses. Outcome parameters included proportion of blood loss, perioperative blood transfusion and blood transfusion rate. Univariate analysis and multiple regression analysis were used to explore the risk factors that led to massive blood loss during surgery. Results: There were 66 patients enrolled in the massive blood loss group, and 106 patients in the control group. When compared to data in the non-large blood loss group by using Univariate analysis, in the massive blood loss group the BMI was significantly lower(P=0.046), the preoperative Cobb angle was larger(P<0.001), the preoperative vertebral offset distance was larger(P=0.002), the fusion levels were more(P<0.001), and the intervertebral fusion segment was more(P=0.043), the osteotomy level was higher(P<0.001), the proportion of intraoperative TXA usage was smaller(P=0.046), and perioperative blood transfusion(P=0.015), blood transfusion rate(P=0.035), postoperative hospital time(P=0.035), hospitalization cost(P=0.023) were higher. Multivariate logistics binary regression analysis showed that when BMI increased 1kg/m2, the risk of massive blood loss during surgery decreased by 9.3%. When the value of Cobb angle correction increased by 1° or the fusion levels increased by 1 segment, the risk of massive blood loss increased by 5.9% and 58.9%, respectively. For each additional unit of intervertebral fusion segment, the risk of massive blood loss increased by 1.174 times. Intraoperative third or higher level osteotomy increased the risk of massive blood loss during surgery by 9.262 times. The usage of TXA during surgery reduced the risk of massive blood loss during surgery by 71.2%. Conclusions: Smaller BMI, larger preoperative Cobb angle, larger preoperative AVT, increased Cobb angle correction, increased fusion level, increased intervertebral fusion level and intraoperative osteotomy, higher osteotomy grade and no use of TXA are potential risk factors of massive blood loss in long-level fusion surgery in patients with DLS. Among them, smaller BMI, increased Cobb angle correction, increased fusion levels, increased intervertebral fusion levels, third or higher level osteotomy and no use of TXA during surgery are independent risk factors for massive blood loss during surgery. |
| 投稿时间：2019-02-20 修订日期：2019-04-28 |
| DOI： |
| 基金项目: |
|
| 摘要点击次数: 2959 |
| 全文下载次数: 2577 |
| 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
