短节段腰椎固定融合术治疗退变性腰椎侧凸的并发症及危险因素分析

Complications and risk factors of short segment fusion for degenerative lumbar scoliosis

中文关键词:  短节段融合  退变性腰椎侧凸  并发症  危险因素

英文关键词:Short segment  Degenerative lumbar scoliosis  Complications  Risk factors

中文摘要:

  【摘要】 目的：回顾性研究后路短节段腰椎固定融合术治疗退变性腰椎侧凸的手术并发症，并分析其相关危险因素。方法：回顾性研究我院2011年1月~2015年12月行后路短节段腰椎固定融合术的退变性腰椎侧凸患者69例。其中男性28例，女性41例。年龄51～82岁，平均66.8±8.7岁。收集所有患者的相关数据，包括一般资料、BMI、高血压病、糖尿病、心脏疾病、脑血管病、术前腰椎侧凸Cobb角、术前腰椎前凸角、手术时间、术中出血量、输血量、固定节段数以及相关并发症（早期并发症：伤口感染、脑脊液漏、硬膜外血肿等；远期并发症：症状性邻近节段退变、内固定失败等）。通过单因素分析上述临床因素与并发症发生的相关性，将有统计学意义的指标应用多因素Logistic回归方程分析，确定并发症发生的危险因素。结果：17例（24.6％）患者出现并发症19例，其中2例（2.9％）患者出现2种并发症，无死亡病例发生。早期并发症包括伤口感染3例（4.3％，深部2例，表浅1例）；脑脊液漏2例（2.9％）；术后短暂下肢麻木或疼痛1例（1.4％）；硬膜外血肿1例（1.4%）；远期并发症包括症状性邻近节段退变（ASD）10例（14.5%），3例再次手术（4.3%）；内固定失败2例（2.9%，连接棒脱落1例，螺钉松动1例）。单因素分析结果提示，早期并发症与糖尿病、术中出血量、手术时间、固定节段数有相关性（P＜0.05）；远期并发症与术前腰椎侧凸Cobb角、术前腰椎前凸角、固定节段数有相关性（P＜0.05）。通过多因素Logistic回归分析模型，确定的早期并发症危险因素是手术时间、固定节段数（P＜0.05），远期并发症危险因素是术前腰椎侧凸Cobb角、术前腰椎前凸角（P＜0.05）。结论：短节段腰椎固定融合术治疗退变性腰椎侧凸最常见的并发症是症状性邻近节段退变，早期并发症的发生受到手术时间和固定节段数的影响，而远期并发症的危险因素是术前腰椎侧凸Cobb角和术前腰椎前凸角。

英文摘要:

  【Abstract】 Objectives: To review the surgical complications of short segmental lumbar fusion for degenerative lumbar scoliosis (DLS), and to analyze potential risk factors. Methods: From January 2011 to December 2015, 69 patients with degenerative lumbar scoliosis receiving short segmental lumbar fusion in our department were retrospectively investigated, including 28 males and 41 females. The mean age was 66.8±8.7 years old (range, 51-82 years). Clinical and surgical data were collected, including demographic information, BMI, hypertension, diabetes, heart disease, cerebrovascular disease, Cobb angle of lumbar scoliosis, preoperative lumbar lordosis, operation time, blood loss and transfusion, fusion segments and surgical complications(early and late). The correlations were analyzed between clinical factors and surgical complications using univariate analysis. Then the statistically significant indicators were integrated into Logistic regression analysis to determine the independent risk factors for complication. Results: The study cohort consisted of 69 cases, including 28 males and 41 females. A total of 17 cases(24.6%) developed surgical complications, while there were two complications in 2 individual patients each(2.9%), with no mortalities. Early complications included wound infection in 3 cases(4.3%, 2 cases of deep infection, 1 case of superficiality infection), cerebrospinal fluid leakage in 2 cases(2.9%), postoperative transient numbness or pain in lower limbs in 1 case(1.4%), epidural hematoma in 1 case(1.4%). Late complications included symptomatic adjacent segment degeneration (SASD) in 10 cases(14.5%) and revision in 3 cases(4.3%), internal fixation failure in 2 cases (rod falling off in 1 case and screw loosening in 1 case, 2.9%). The results of univariate analysis showed that the early complications were related to diabetes, intraoperative blood loss, operation time and fixed segment number(P<0.05); the late complications were related to Cobb angle of lumbar scoliosis, lumbar lordosis angle and fixed segment number(P<0.05). The multivariate Logistic regression analysis showed that the risk factors of early complications include operation time and fusion segments(P<0.05). The risk factors of late complications consist of Cobb angle of lumbar scoliosis and preoperative lumbar lordosis(P<0.05). Conclusions: Symptomatic adjacent segment degeneration is the most common complication of short segment lumbar fusion for degenerative lumbar scoliosis. The risk factors of early complications include operation time and fusion segments, and that of late complications include Cobb angle of lumbar scoliosis and preoperative lumbar lordosis.