颈前路植骨融合术治疗急性下颈段脊髓损伤早期并发症的危险因素分析

Risk factors for early complications after anterior bone grafting and fusion surgery in patients with acute subaxial cervical spinal cord injury

中文关键词:  下颈段脊髓损伤  术后并发症  危险因素

英文关键词:Subaxial cervical spinal cord injury  Postoperative complication  Risk factors

中文摘要:

  【摘要】 目的：探讨采用颈前路植骨融合术治疗急性下颈段脊髓损伤患者术后早期并发症的危险因素。方法：回顾性分析我院2017年1月~2021年11月行前路手术治疗的创伤性颈脊髓损伤的168例患者临床资料。男133例，女35例。年龄23~82岁，平均53.8±11.2岁。伴术前合并症33例（19.6%），术前患者神经功能损害ASIA分级A级34例，B级10例、C级62例，D级62例，其中使用激素冲击治疗50例（29.8%）。采用ACDF手术135例（80.4%），ACCF手术33例（19.6%）。收集患者住院期间的术后早期并发症及死亡等信息，先行单因素Logistic回归分析，观察性别、年龄、术前合并症、受伤原因、神经损伤平面、术前ASIA分级、是否合并颅脑或胸腹部损伤、是否使用大剂量激素治疗、受伤至手术时间、术前血红蛋白（HGB）、术前白蛋白（ALB）、手术范围、手术方式、手术时间、术中出血量与并发症的相关性，并对P<0.2的变量行多因素Logistic回归分析术后早期并发症的危险因素。结果：术后早期并发症发生率为29.1%（49/168）。单因素Logistic回归分析显示受伤原因（P=0.032）、术前ASIA分级（P＜0.001）、是否合并颅脑或胸腹部损伤（P=0.043）、是否使用激素冲击治疗（P=0.017）、术前HGB（P=0.002）、术前ALB（P=0.001）和手术方式（P=0.002）与术后早期并发症相关。多因素Logistic回归分析表明术前ASIA分级为A级、B级（P＜0.001，OR=5.389，95%CI 2.243~12.950）和使用激素冲击治疗（P=0.044，OR=2.541，95%CI 1.024~6.303）为术后早期并发症的独立危险因素。结论：术前ASIA分级为A级、B级和使用大剂量激素治疗为急性下颈段脊髓损伤患者术后早期并发症的危险因素。

英文摘要:

  【Abstract】 Objectives: To investigate the risk factors of early postoperative complications in patients with acute subaxial cervical spinal cord injury after anterior bone grafting and fusion surgery. Methods: The clinical data of 168 cases of traumatic cervical spinal cord injury who underwent anterior surgery in our hospital from January 2017 to November 2021 were retrospectively analyzed. There were 133 males and 35 females. The age ranged from 23 to 82 years, with an average age of 53.8±11.2 years. There were 33 patients with preoperative comorbidities(19.6%). ASIA classification of preoperative neurological impairment was as follows: 34 patients of grade A, 10 patients of grade B, 62 patients of grade C, and 62 patients of grade D. 50 patients were treated with high-dose methylprednisolone(29.8%). 135 cases(80.4%) were treated with anterior cervical discectomy and fusion(ACDF), and 33 cases(19.6%) were treated with anterior cervical corpectomy and fusion(ACCF). Early postoperative complications and death of patients during hospitalization period were collected. Univariate logistic regression analysis was used to evaluate possible relationships between early postoperative complications and the factors including sex, age, preoperative comorbidities, cause of injury, neurological level of injury, preoperative ASIA grade, whether there was brain, thoracic and abdominal injury, whether high-dose methylprednisolone treatment was used, time from injury to surgery, preoperative hemoglobin(HGB), preoperative albumin(ALB), extent of surgery, surgical method, operative time, and intraoperative blood loss. A multivariate logistic analysis was performed on the variables with P<0.2 in the univariate analysis to identify significant independent risk factors. Results: The incidence of early postoperative complications was 29.1%(49/168). Univariate logistic regression analysis showed that the cause of injury(P=0.032), preoperative ASIA grade(P＜0.001), whether combined with brain, thoracic and abdominal injury(P=0.043), whether high-dose methylprednisolone treatment was used(P=0.017), preoperative HGB(P=0.002), preoperative ALB(P=0.001) and surgical method(P=0.002) were correlated with early postoperative complications. Multivariate logistic regression analysis showed that preoperative ASIA grades A and B(P＜0.001, OR=5.389, 95%CI 2.243-12.950) and high-dose methylprednisolone treatment(P=0.044, OR=2.541, 95%CI 1.024-6.303) were independent risk factors for early postoperative complications. Conclusions: Preoperative ASIA grades A and B and high-dose methylprednisolone treatment are the independent risk factors for early postoperative complications in patients with acute subaxial cervical spinal cord injury.