胸椎黄韧带骨化症术后脑脊液漏的相关因素△

Factors related to cerebrospinal fluid leakage in posterior decompression of thoracic ossification of ligamentum flavum

摘要:

［目的］探索后路全椎板切除术治疗胸椎黄韧带骨化症脑脊液漏（leakage of cerebrospinal fluid, CSFL）的发生率和相关因素，为临床预防提供依据。［方法］ 采用回顾性队列研究方法，分析 2015 年 8 月—2021 年 8 月诊断为胸椎黄韧带骨化症并行后路全椎板切除术治疗患者的临床资料，根据术后是否并发脑脊液漏分为 CSFL 组和无 CSFL 组，采用单项因素比较及二元多因素逻辑分析 CSFL 的相关因素。［结果］共 108 例患者纳入本研究，28 例并发 CSFL，发生率为 25.9%。单项因素比较表明：与无 CSFL 组相比，CSFL 组术前双下肢瘫痪比率显著高（P<0.05）；影像上椎管面积残余率、正中线前后径残余率、矢状位前后径残余率均显著小（P<0.05）；此外，术中采用传统骨凿比率显著高（P<0.05），手术节段数显著多（P<0.05），手术时间和住院时间显著长（P<0.05）。但是，两组年龄、性别、BMI、病程、二便功能障碍、术前 mJOA、饮酒史、吸烟史、术前合并症（高血压、糖尿病）、Sato 分型、MRI 分型、侧界前后径残余率、旁正中前后径残余率及手术部位的差异均无统计学意义（P>0.05）。 逻辑回归表明：手术节段多 （OR=4.272，P=0.007）、椎管面积残余率小 （OR=0.903，P<0.001） 是 CSFL 发生的独立危险因素。 ［结论］手术节段多、椎管面积残余率低的患者发生 CSFL 的风险增高，应采取针对性的措施，以减少 CSFL 的发生。

Abstract:

[Objective] To explore the incidence and related factors of cerebrospinal fluid leakage (CSFL) in posterior total laminectomy for decompression of thoracic ossification ligamentum flavum to provide a reference for clinical prevention of CSFL. [Methods] A retrospec- tive cohort study was conducted on patients who received posterior total laminectomy for decompression of thoracic ossification of ligamen- tum flavum between August 2015 and August 2021. According to whether CSFL happened, the patients were divided into the CSFL group and non-CSFL group. The univariate comparison, and multiple binary logic regression were conducted to search the factors related to CSFL. [Results] Of the 108 patients included in this study, 28 patients had CSFL, accounting for 25.93%. In term of univariate comparison, the CS- FL group had significantly higher ratio of preoperative limb paralysis (P＜0.05); significantly less residual rate of spinal canal area, the residu- al rate of diameter of the canal on the midline and the residual rate of the sagittal diameter on the images (P＜0.05); additionally, significantly higher ratio of intraoperative conventional bone chisels used (P＜0.05), significantly more number of segments involved (P＜0.05), as well as significantly longer operation time and hospital stay than the non-CSFL group (P＜0.05). However, there were no significant differences be- tween the two groups in age, gender, BMI, course of disease, bladder and bowel dysfunction, preoperative JOA score, drinking history, smok- ing history, preoperative comorbidities, such as hypertension, diabetes, Sato classification, MRI grade, residual rate of transverse and antero- posterior diameter, residual rate of paramedian diameter and surgical site (P＞0.05). As result of logistic regression, the more segments in- volved (OR=4.272, P=0.007) and small residual rate of spinal canal area (OR=0.903, P＜0.001) was an independent risk factor for CSFL. [Conclusion] More thoracic segments involved and less residual rate of spinal canal area are associated with higher risk of CSFL. The corre- sponding measures should be taken to reduce the occurrence of CSFL.