经椎弓根椎体截骨术治疗强直性脊柱炎后凸畸形术中大量出血的预测

Predictors of massive blood loss in pedicle subtraction osteotomy for ankylosing spondylitis kyphosis

目的探讨经椎弓根椎体截骨术(pedicle subtraction osteotomy,PSO)治疗强直性脊柱炎(ankylosing spondylitis,AS)后凸畸形术中大量出血(massive blood loss,MBL)的预测因素。方法共收集147例PSO治疗AS后凸畸形的病例数据。其中106例资料完整,分为两组:A组(n=69)术中出血量≥估计血容量的30%,B组(n=37)术中出血量<估计血容量的30%。比较两组患者术前数据,应用单因素分析大量出血所有可能的预测因素。应用多因素Logitic回归分析大量出血的独立危险因素。应用Pearson相关性检验分析全部106例大量出血的发生率与脊柱外科医生PSO手术积累量的关系。结果 A组患者(65%)中,GK角≥70°、固定节段数≥≥9、双节段截骨的例数比B组(35%)更多。Logistic回归分析显示固定节段数≥9以及双节段截骨是大量出血的独立危险因素。Pearson相关性分析显示在一定范围内,大量出血的发生率随着脊柱外科医生PSO手术积累量的增加而下降,二者呈线性相关。结论 PSO手术治疗AS后凸畸形的患者中,大量出血的发生率为65%。术前GK角≥70°、双节段PSO截骨以及固定节段数≥9是大量出血的预测因素,后两者是独立预测因素。在一定范围内,随着脊柱外科医生PSO手术量的积累,大量出血的发生率下降。

Objective To investigate the predictors of massive blood loss （ MBL ） in pedicle subtraction osteotomy （ PSO ） in the treatment of spinal kyphosis caused by ankylosing spondylitis （ AS ）.Methods A total of 147 patients with spinal kyphosis caused by AS underwent PSO, whose clinical data were collected. Among them, the data of 106 patients were complete, who were divided into 2 groups. In group A （n=69 ） the intraoperative blood loss was more than or equal to 30% of the estimated blood volume, and in group B （n=37 ） the intraoperative blood loss was less than 30% of the estimated blood volume. The preoperative data were compared between the 2 groups, and univariate analysis was undertaken to distinguish all the possible predictors of MBL. And a binary logistic regression analysis was used to determine the independent risk factors of MBL. The relationship between the incidence of MBL in all the 106 cases and the cumulative amount of PSO by spine surgeons was analyzed with the Pearson correlation test.Results There were more cases of double-segment osteotomy in group A （ 65% ） than in group B （ 35% ）, with the global kyphosis （ GK ）≥70o and the number of ifxation segments≥9. Logistic regression analysis showed that more than or equal to 9 ifxation segments and double-segment osteotomy were independent risk factors for MBL. The Pearson correlation test showed that the incidence of MBL was decreased with the increase of the cumulative amount of PSO by spine surgeons in a certain range and a linear correlation was found between them.Conclusions When PSO is performed in the treatment of spinal kyphosis caused by AS, the incidence of MBL is 65%. The predictors of MBL included the preoperative Cobb’s angle≥70o, double-segment PSO and number of ifxation segments≥9, and the last 2 predictors are independent. In a certain range, with the increase of the cumulative amount of PSO by spine surgeons, the incidence of MBL will be decreased.