后路环形减压术治疗胸椎后纵韧带骨化症术后脑脊液漏的危险因素分析

Risk factors of the cerebrospinal fluid leakage after posterior circumferential decompression for thoracic ossification of posterior longitudinal ligament

中文关键词:  脑脊液漏  环形减压  后纵韧带骨化症  胸椎  危险因素

英文关键词:Cerebrospinal fluid leakage  Circumferential decompression  Ossification of posterior longitudinal ligament  Thoracic  Risk factors

中文摘要:

  【摘要】 目的：回顾性分析后路经关节突脊髓环形减压术治疗胸椎后纵韧带骨化症（ossification of posterior longitudinal ligament，OPLL）发生术后脑脊液漏（cerebrospinal fluid leakage，CSFL）的相关危险因素。方法：2015年8月～2019年12月，共有50例胸椎OPLL患者在我院行后入路经关节突脊髓环形减压手术，其中男26例，女24例；年龄27～82岁（53.0±13.3岁）。根据术后是否出现了脑脊液漏将患者分为脑脊液漏组（CSFL组）和无脑脊液漏组（非CSFL组）。比较两组患者的基本情况、影像学资料以及手术资料的差异，将存在统计学差异的指标采用多因素Logistic回归分析得出术后CSFL的可能危险因素。结果：50例患者均顺利完成手术，手术时间80～354min（173.7±68.7min），术中出血量50～3500ml（1019.8±746.3ml）。术后14例患者发生CSFL，发生率为28%，其中男性6例，女性8例，平均年龄49.4±11.8岁。比较CSFL组和非CSFL组的基本资料、术前影像学资料以及手术资料，发现两组的吸烟史、切除椎板数、环形减压部位、是否合并黄韧带骨化（ossification of ligamentum lavum，OLF）、椎管侵占率、OPLL基底比存在统计学差异（P＜0.05）。多因素Logistic回归分析显示吸烟史、环形减压部位、OPLL基底比为CSFL的危险因素：吸烟的患者发生CSFL的概率是不吸烟患者的43.8倍；上胸段和中胸段环形减压发生CSFL的概率分别是下胸段的21.9倍和33.1倍；OPLL基底比与CSFL发生率显著正相关（OR=1.2，P=0.013）。结论：吸烟史和上、中胸段环形减压、OPLL宽基底是术后脑脊液漏的危险因素，对于有明确吸烟史、上/中胸段部位及骨化物基底部较宽的胸椎OPLL患者，术中需要积极保护硬膜囊，防止术后脑脊液漏的发生。

英文摘要:

  【Abstract】 Objectives: This study aimed to retrospectively evaluate the related risk factors of the cerebrospinal fluid leakage after posterior transarticular osteotomy and circumferential decompression for thoracic ossification of posterior longitudinal ligament(OPLL). Methods: A total of 50 patients with thoracic OPLL underwent posterior transarticular osteotomy and circumferential decompression from August 2015 to December 2019, including 26 males and 24 females. The age ranged from 27 to 82 years old, with an average age of 53.0±13.3 years. The patients were divided into CSLF group and non-CSFL group according to whether they suffered cerebrospinal fluid leakage. The incidence and outcomes of CSFL was analyzed, and to compare the demographic characteristics，radiological and surgical data between CSFL group and non-CSFL group. the risk factors were obtained according to the multivariate Logistic regression analysis used indexes with statistic differences. Results: All patients underwent surgery. The operation time was 80-354min, average operation time was 173.7±68.7min. The mean blood loss was 1019.8±746.3ml(range 50-3500ml). There were 14 patients(28%) underwent CSFL postoperatively, including 6 males and 8 females, with an average age of 49.4±11.8 years. There were statistical differences in smoking history, number of laminectomy, segment of circumferential decompression, ossification of ligamentum lavum(OLF), Occupying ratio, base ratio of OPLL between CSFL group and non-CSFL group(P<0.05). Multivariate Logistic regression analysis showed that smoking history, segment of circumferential decompression and base ratio of OPLL were risk factors for CSFL. The probability of CSFL in smokers was 43.8 times that of non-smokers. The incidence of CSFL was 21.9 and 33.1 times higher if the circumferential decompression were underwent at the upper and middle thoracic than that at the lower thoracic, respectively. Besides, the ratio of OPLL base(OR=1.09, P=0.012) could be risk factors for CSLF. Conclusions: Smoking history, upper and middle thoracic circumferential decompression and broad-based OPLL are risk factors for postoperative CSFL. If any of these factor exist in patients, surgeons need to pay more attention to protecting the dural sac to prevent postoperative cerebrospinal fluid leakage.