内镜下腰椎融合术失血的相关因素
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葛志林,硕士研究生,研究方向:脊柱退变性疾病,(电话)18588499686,(电子信箱)1280466264@qq.com

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R687

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玉林市科学技术局科技计划项目(编号:玉市科 20220631)


Factors associated with blood loss in endoscopic lumbar interbody fusion
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    摘要:

    [目的]探讨内镜下腰椎融合术隐性失血量的相关因素。[方法]回顾性分析 2018 年 9 月—2022 年 6 月行内镜下腰椎融合术的 120 例患者的临床资料,其中,经椎间孔入路内镜下腰椎融合术 (endoscopic transforaminal lumbar interbody fusion, E-TLIF)37 例,经椎板间内镜下腰椎融合术(endoscopic posterior lumbar interbody fusion, E-PLIF)30 例,单侧双通道内镜下腰椎融合术(unilateral biportal posterior endoscopic lumbar interbody fusion, UBE-PLIF)53 例。采用单项因素比较,单因素相关分析和多元线性逐步回归分析隐性失血的相关因素。[结果]所有患者均顺利完成手术,三组间手术时间、术前 Hb、RBC、Hct 及凝血指标的差异均无统计学意义(P>0.05)。术后三组 Hb、RBC、Hct 均较术前显著下降(P<0.05)。E-TLIF 组和 E-PLIF 组术后上述指标间差异无统计学意义 (P>0.05)。UBE-PLIF 组术后 1 d Hb [(111.7±12.7) g/L vs (123.9±16.0) g/L, P<0.05]、RBC [(4.0±0.7)× 1012 vs (4.4±0.6)×1012, P<0.05]、Hct [(34.7±5.0)% vs (36.8±4.7)%, P<0.05] 显著低于 E-TLIF 组。UBE-PLIF 的术中失血量 [(161.8± 77.9) ml vs (63.8±45.1) ml vs (56.3±30.1) ml, P<0.05]、总失血量 [(553.8±459.7) ml vs (257.2±283.1) ml vs (262.5±302.3) ml, P<0.05]、隐性失血量 [(392.1±419.2) ml vs (193.4±269.9) ml vs (145.5±205.2) ml, P<0.05] 均显著多于 E-TLIF 组和 E-PLIF 组,E-TLIF 组和 EPLIF 组间上述指标差异无统计学意义(P>0.05)。单因素相关分析显示,手术方式和术前 Hct 与隐性失血量呈显著正相关(P< 0.05)。多元线性回归分析显示,UBE-PLIF 手术方式、术前 Hct 是隐性失血量的独立危险因素(P<0.05)。[结论]内镜下腰椎融合术也存在大量隐性失血可能,其中 UBE-PLIF 手术隐性失血的风险更大。

    Abstract:

    [Objective] To investigate the factors related to hidden blood loss in endoscopic lumbar interbody fusion. [Methods] A retrospective study was conducted in 120 patients who underwent endoscopic lumbar interbody fusion from September 2018 to June 2022. Of them, 37 patients underwent endoscopic transforaminal lumbar interbody fusion (E-TLIF), 30 patients underwent endoscopic posterior lumbar interbody fusion (E-PLIF), and 53 patients were treated with unilateral biportal endoscopic posterior lumbar interbody fusion (UBEPLIF). The univariate comparison, univariate correlation and multiple linear stepwise regression were conducted to research the factors related to the hidden blood loss. [Results] All patients had surgical procedures accordingly performed successfully with no significant differences in operation time, preoperative Hb, RBC, Hct and coagulation parameters among the three groups (P>0.05). The Hb, RBC and Hct of all the three groups significantly decreased after surgery (P<0.05), which were not significantly different between E-TLIF group and E-PLIF group (P>0.05), whereas the UBE-PLIF group was significantly lower than the E-TLIF group in terms of Hb [(111.7±12.7) g/L vs (123.9±16.0) g/L, P<0.05], RBC [(4.0±0.7) 1012 vs (4.4±0.6) 1012, P<0.05] and Hct [(34.7±5.0)% vs (36.8±4.7)%, P<0.05]. In addition, the UBE-PLIF group proved significantly greater than the E-TLIF and E-PLIF groups in terms of intraoperative blood loss [(161.8±77.9) ml vs (63.8±45.1) ml vs (56.3±30.1) ml, P<0.05], total blood loss [(553.8±459.7) ml vs (257.2±283.1) ml vs (262.5±302.3) ml, P<0.05] and hidden blood loss [(392.1± 419.2) ml vs (193.4±269.9) ml vs (145.5±205.2) ml, P<0.05], whereas there was no significant differences in the above indexes between the E-TLIF group and the E-PLIF group (P>0.05). As consequence of univariate correlation, the surgical method (UBE-PLIF) and preoperative Hct were significantly positively correlated with hidden blood loss (P<0.05). Regarding to multiple linear regression analysis, the UBE-PLIF and preoperative Hct were independent risk factors for hidden blood loss (P<0.05). [Conclusion] Endoscopic lumbar interbody fusion also has the possibility of large amounts of hidden blood loss perioperatively, especially the UBE-PLIF.

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葛志林,龙海光,钟家云,等. 内镜下腰椎融合术失血的相关因素[J]. 中国矫形外科杂志, 2024, 32 (4): 289-295. DOI:10.3977/j. issn.1005-8478.2024.04.01.
GE Zhi-lin, LONG Hai-guang, ZHONG Jia-yun, et al. Factors associated with blood loss in endoscopic lumbar interbody fusion[J]. Orthopedic Journal of China , 2024, 32 (4): 289-295. DOI:10.3977/j. issn.1005-8478.2024.04.01.

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  • 收稿日期:2023-02-17
  • 最后修改日期:2023-10-26
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  • 在线发布日期: 2024-02-29
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