腰椎手术硬膜撕裂的危险因素分析

RISK FACTORS FOR INCIDENTAL DUROTOMY DURING LUMBAR SURGERY

目的探讨腰椎手术中发生硬膜撕裂(icidental durotomy,ID)的危险因素。方法于2010年1月-2012年12月行腰椎手术的2 235例患者中,选择发生ID且符合选择标准的86例患者,以及手术医生、手术时间与ID患者匹配的86例未发生ID患者纳入研究。比较两组患者性别、年龄、体质量指数、吸烟史、酗酒史、非甾体类药物使用史、病因、腰椎手术史、是否为翻修手术、手术入路、骨质疏松、糖尿病以及手术方式的差异,采用Logistic回归分析发生ID的危险因素。结果发生与未发生ID患者在病因、手术入路、是否为翻修手术、腰椎手术史和手术方式方面,差异均有统计学意义(P<0.05),纳入多因素分析。Logistic回归分析示既往行腰椎手术、翻修手术及微创手术是腰椎手术中发生ID的危险因素(P<0.05)。结论存在腰椎手术史、翻修手术及选择微创手术是腰椎手术过程中发生ID的危险因素,对于此类患者术中操作时应注意预防ID的发生。

Objective To evaluate the risk factors for incidental durotomy （ID） during lumbar surgery. Methods Eighty-six patients with ID and 86 patients with no ID （who were matched 1 ： i in surgeons and surgery time） were selected from 2 235 patients who underwent lumbar surgery between January 2010 and December 2012. The gender, age, body mass index, history of smoking, alcoholism, nonsteroidal drug use, the etiology, lumbar surgery history, revision surgery, surgical approach, osteoporosis, diabetes, and surgical procedure were compared between 2 groups. Logistic regression analysis was applied to analyze the risk factors for ID. Results There was significant difference （P〈0.05） in etiology, surgical approach, revision surgery, lumbar surgery history, and surgical procedure between patients with ID and patients with no ID, which were then included in multivariate analysis. Logistic regression analysis demonstrated that lumbar surgery history, revision surgery, and minimal invasive surgery were risk factors for ID during lumbar surgery （P〈0.05）. Condusion Lumbar surgery history, revision surgery, and minimal invasive surgery were risk factors for ID during lumbar surgery, thus surgery for patients with the above histories should be carefully performed to prevent ID.