腰椎退行性病斜外侧椎间融合隐性失血的相关因素

Factors related to hidden blood loss in oblique lumbar interbody fusion for degenerative lumbar diseases

摘要:

［目的］分析斜外侧腰椎椎体间融合术（oblique lumbar interbody fusion, OLIF）治疗腰椎退变性疾病术后隐性失血及相关影响因素。［方法］回顾性分析 2016 年 5 月—2019 年 12 月本院采用 OLIF 治疗腰椎退变性疾病 45 例患者的临床资料，计算患者隐性失血量，采用按因素分层比较和多元线性逐步回归分析筛选出隐性失血量的相关因素。［结果］所有患者均顺利完成手术， 手术时间平均（183.36±62.53）min，显性失血量平均（120.78±108.31）ml。根据公式计算总失血量平均（758.95±393.05）ml，隐性失血量平均（638.17±371.75）ml，占总失血量的（81.09±16.54）%。因素分层比较，按年龄、性别、BMI、手术节段数、是否糖尿病、是否高血压、是否脊柱畸形和植骨类型分层的隐性失血量差异均无统计学意义（P>0.05）。按手术时间、学习曲线、是否使用氨甲环酸分层的隐性失血量差异有统计学意义 （P<0.05）。多元线性逐步回归分析表明，学习曲线 （手术顺序数）（B=- 12.171，P=0.002），氨甲环酸是否使用（B=-246.090，P=0.015）与隐性失血量呈显著负相关（P<0.05）。［结论］OLIF 技术治疗腰椎退变性疾病存在较多的隐性失血，隐性失血量与学习曲线、氨甲环酸使用与否密切相关，需引起临床医师的重视。

Abstract:

[Objective] To analyze the hidden blood loss in oblique lumbar interbody fusion (OLIF) for degenerative lumbar diseases, and the factors related to it. [Methods] A retrospective analysis was performed on 45 patients who received OLIF for degenerative lumbar diseases in our hospital from May 2016 to December 2019. The hidden blood loss was calculated, and the factors related to hidden blood loss were screened out by stratification factors and multiple linear stepwise regression analysis. [Results] All patients had operation completed success- fully, with operation time of (183.36±62.53) min, the dominant blood loss of (120.78±108.31) ml. The mean total blood loss was (758.95± 393.05) ml while the hidden blood loss was (638.17±371.75) ml, accounting for (81.09±16.54) % of the total blood loss. There were no statisti- cally significant differences in hidden blood loss in terms of stratification of age, sex, BMI, number of surgical levels, diabetes, hypertension, spinal deformity, and bone graft type (P＜0.05) . However, there were statistically significant differences in hidden blood loss by stratifications of operation time, learning curve, and whether or not tranexamic acid used (P＜0.05) . As results of multiple linear stepwise regression, the learn- ing curve (number of surgical sequence) (B=-12.171, P=0.002) and the amount of tranexamic acid used (B=-246.090, P=0.015) were signifi- cantly negatively correlated with the amount of hidden blood loss. [Conclusion] There is considerable amount of hidden blood loss in OLIF for degenerative lumbar diseases, which is closely related to learning curve and tranexamic acid usage, should be paid attention to by clinicians.