腰椎后路减压融合术并发脑脊液漏的多因素分析

Multivariate analysis of risk factors for cerebrospinal fluid leakage following lumbar laminectomy decompression with fusion

中文关键词:  腰椎  脊柱融合术  脑脊液漏  危险因素  Logistic回归

英文关键词:Lumbar  Spinal fusion  Cerebrospinal fluid leakage  Risk factors  Logistic regression

中文摘要:

  【摘要】 目的：探讨腰椎后路减压融合术并发脑脊液漏的危险因素，为临床预防脑脊液漏的发生提供依据。方法：回顾2001年1月～2011年12月收治的758例因腰椎管狭窄症行腰椎后路减压融合术患者的病史及随访资料，以是否并发脑脊液漏将患者分为两组，记录患者的年龄、性别、吸烟饮酒史、有无合并糖尿病、体重指数（body mass index，BMI)、既往手术史、病程、手术方式、手术节段数、最低手术节段及术中有无调整螺钉位置。将上述可能与并发脑脊液漏相关的因素先行单因素分析，筛选出有统计学差异的因素再行多因素Logistic回归，分析其与腰椎后路减压融合术并发脑脊液漏的关系。结果：758例患者中99例并发脑脊液漏，脑脊液漏的发生率为13.1%（99/758），首次手术脑脊液漏的发生率为10.3%（66/638），翻修手术为27.5%（33/120）。99例并发脑脊液漏患者中，45例术中即发现硬膜损伤或脑脊液漏，54例（54.5%）为迟发性脑脊液漏，术中未发现硬膜损伤或脑脊液漏，迟发性脑脊液漏出现时间为术后1～9d。单因素分析结果显示两组病例在年龄、吸烟、病程、翻修手术、手术节段数、最低手术节段方面差异有统计学意义（P＜0.05）；多因素Logistic回归分析显示，年龄（OR=2.153， 95% CI=1.045-4.433）、吸烟（OR=1.615，95% CI=1.015-2.572）、翻修手术（OR=3.386，95% CI=2.047-5.603）、手术的节段数（OR=2.503，95% CI=1.580-3.966）及最低手术节段（OR=2.391，95% CI=1.085-5.269）是并发脑脊液漏的危险因素（P＜0.05）。结论：年龄、吸烟、翻修手术、手术的节段数及最低手术节段对腰椎后路减压融合术并发脑脊液漏有重要影响。

英文摘要:

  【Abstract】 Objectives: To elucidate the prevalence of cerebrospinal fluid(CSF) leakage and explore its risk factors following lumbar laminectomy decompression with fusion, in addition, to provide references for prevention and managements. Methods: A total of 758 patients undergoing lumbar laminectomy decompression with fusion due to lumbar spinal stenosis was eligible for this study during January 2001 and December 2011. Data of age, gender, smoking history, alcohol use, diabetes, body mass index(BMI), duration of symptoms, revision surgery, surgical method, presence of intraoperative adjustment of pedicle screws, number of surgical levels, the lowest surgical level and presence of CSF leakage were collected by respectively reviewing patients′ medical records. Patients were divided into two groups according to the presence of CSF leakage. Univariate analysis was firstly used to explore significant factors for CSF leakage, and then these factors were measured by multivariate logistic analysis to identify the risk factors for CSF leakage following lumbar laminectomy decompression with fusion. Results: The incidence of CSF leakage following lumbar laminectomy decompression with fusion was 13.1%(99 of 758 cases). The incidence of CSF leakage following primary surgeries was 10.3%(66 of 638 cases), which compared to an incidence of 27.5% for revision surgery(33 of 120 cases). Of 99 cases with CSF leakage, 45 cases suffered from dural tear(DT) or CSF leakage during surgery, and 54 patients were complicated with delayed CSF leakage without intraoperative DT or CSF leakage which occurred at 1 to 9 days after surgery. Univariate analysis showed statistical differences in age, smoking, duration of symptoms, revision surgery, number of surgical levels and the lowest surgical level(P<0.05). Multivariate logistic analysis showed the age(OR=2.153, 95% CI=1.045-4.433), smoking(OR=1.615, 95% CI=1.015-2.572), revision surgery(OR=3.386, 95% CI=2.047-5.603), number of surgical levels(OR=2.503, 95% CI=1.580-3.966) and the lowest surgical level(OR=2.391, 95% CI=1.085-5.269) were risk factors for this complication(P<0.05). Conclusions: Age, smoking, revision surgery, number of surgical levels and the lowest surgical level seriously affect the incidence of CSF leakage.