腰椎椎间融合术后神经并发症的相关因素△

Factors related to postoperative neurological complications in lumbar interbody fusion

摘要:

［目的］分析腰椎椎间融合术神经损伤的独立危险因素，为预防术后神经并发症提供参考。［方法］ 回顾性分析 2015 年 9 月—2020 年 6 月本院采用后路腰椎椎体间融合术（posterior lumbar interbody fusion, PLIF）或经椎间孔入路腰椎椎体间融合术 （transforaminal lumbar interbody fusion, TLIF） 治疗腰椎退行性疾病 （lumbar degenerative disease, LDD） 的 418 例患者的临床资料。依据术后是否出现神经损害将患者分为损害组和无损害组。采用单项因素比较和多因素二元逻辑回归分析术后神经损害发生的独立危险因素。［结果］ 418 例患者中，术后神经损害症状加重患者 28 例，占 6.7%；无神经损害者 390 例，占 93.3%，神经损害症状加重发生时间术后 24 h 内。单项因素比较表明：与无损害组相比，损害组的 BMI 显著大，病程显著长， 术前诊断为 LSS 或 DLS 的比率显著高，滑脱程度显著重，翻修手术占比显著高，PLIF 术式比率显著高（P<0.05）。但是，两组间性别、年龄、滑脱节段数、ASA 分级、是否合并高血压、糖尿病、冠心病、手术时间、术中出血量、引流管留置时间、手术前后血红蛋白水平、手术前后白蛋白水平的差异均无统计学意义 （P<0.05）。逻辑回归分析显示，病程 （OR=1.322，P< 0.001）、BMI （OR=3.325，P=0.003）、PLIF 手术 （OR=10.017，P=0.002）、伴有腰椎滑脱 （OR=4.572，P=0.006）、翻修手术 （OR=6.182，P=0.008）是腰椎后路椎间融合术后出现神经并发症的独立危险因素。［结论］病程长、肥胖、PLIF 手术、腰椎滑脱、翻修手术的患者术后出现神经并发症的风险较高，应针对性采取措施以减少神经损伤的发生。

Abstract:

[Objective] To search the independent risk factors related to nerve injury in lumbar interbody fusion, and to provide a refer- ence for the prevention of the neurological complications. [Methods] A retrospective study was conducted on 418 patients who received pos- terior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases (LDDs) in our hos- pital from September 2015 to June 2020. The patients were divided into the impaired group and the non-impaired group according to wheth- er neurological damage was found after surgery. The independent risk factors of postoperative nerve damage were analyzed by univariate comparison and multi-factor binary logistic regression. [Results] Among the 418 patients, 28 patients (6.7%) had aggravated neurological injury symptoms after surgery, while the remaining 390 patients (93.3%) had no nerve damage symptoms occurred within 24 hours after op- eration. In term of univariate comparison, the patients in the impaired group had significantly higher BMI, significantly longer disease course, significantly higher rate of preoperative diagnosis of lumbar spinal stenosis (LSS) or degenerative lumbar spondylolisthesis (DLS), significantly heavier degree of slippage, significantly higher percentage of revision surgery, and significantly higher ratio of PLIF surgery compared with those in the non- impaired group (P＜0.05). However, there were no statistically significant differences between the two groups regarding gender, age, number of slip segments, ASA grade, whether comorbidities with hypertension, diabetes, coronary heart dis- ease, as well as operation time, intraoperative blood loss, catheter indwelling time, hemoglobin and albumin level before and after surgery (P＞0.05). As results of logistic regression, the course of disease (OR=1.322, P＜0.001), BMI (OR=3.325, P=0.003), PLIF surgery (OR= 10.017, P=0.002), combined lumbar spondylolisthesis (OR=4.572, P=0.006), revision surgery (OR=6.182, P=0.008) were the independent risk factor related to neurological complications in lumbar interbody fusion. [Conclusion] The patients with long course of disease, obesity,PLIF surgery, lumbar spondylolisthesis and revision surgery are at higher risk of postoperative neurological complications, and targeted measures should be taken to reduce the occurrence of nerve injury.