腰椎术后硬膜外血肿的危险因素和临床转归

Postoperative lumbar spinal epidural hematoma: risk factors and clinical outcomes

目的 ：探讨腰椎手术后硬膜外血肿形成的危险因素,并随访血肿清除术后患者神经功能恢复情况。方法：2009年1月~2014年1月在北京医院骨科因腰椎管狭窄症或腰椎间盘突出症行腰椎后路减压椎弓根螺钉内固定术的患者共1225例,术后发生硬膜外血肿致马尾神经功能受损的患者共8例,收集和整理血肿患者的一般资料,并对其血肿清除手术后神经功能恢复情况进行随访。采取病例对照研究的方法,按照每1例腰椎术后硬膜外血肿患者随机选取3例诊断、手术方式及手术医师均相同的24例患者作为对照。对两组患者的年龄、性别、高血压病史、糖尿病病史、非甾体类镇痛药物应用、抗血小板聚集药物的应用、是否为翻修手术,及手术融合节段数、手术时间、术中失血量、输红细胞悬液量、是否输注了冰冻血浆进行多元回归分析,采用多元Logistic回归模型确定每个因素是否为硬膜外血肿形成可能的危险因素,计算其OR（Odd′s Ratio）值。结果 ：多元Logistic回归模型回归分析结果显示,手术前危险因素是年龄〉65岁和翻修手术,手术中危险因素是手术时间〉120min、失血量〉600ml、手术中输注了冰冻血浆。血肿清除术后神经功能完全恢复者2例,部分恢复者4例,无恢复者2例。结论：患者年龄〉65岁、翻修手术、手术时间〉120min、术中出血量〉600ml、术中输注冰冻血浆是腰椎手术后硬膜外血肿形成的危险因素;血肿清除术后大部分患者神经功能得到不同程度恢复。

Objectives： To investigate the risk factors of postoperative lumbar spinal epidural hematoma and the neurological outcomes. Methods： From January 2009 to January 2014, 1225 cases with lumbar disc herniation（LDH） or lumbar spinal stenosis（LSS） underwent decompression and instrumentation in our department. 8of them were complicated with epidural hematoma which caused neurologic deterioration. All these patients were followed up. 24 patients with the same diagnosis and undergoing the same operation by the same surgeon were selected as control. The age, gender, hypertension history, diabetes mellitus（DM） history, non-steroidal anti-inflammatory drugs（NSAIDs） taken history, use of anticoagulation, revision surgery or not, number of fusion segments, operation time, blood loss, frozen plasma transfusion of two groups were recorded. The data were analyzed by using multiple Logistic regression model to determine the significance of the individual factor and the odds ratios（OR）. Results： Through multiple Logistic regression, it was found that age of more than 65 years old and revision surgery were the preoperative risk factors, while operation time of more than120 minutes, blood loss of more than 600 ml, frozen plasma transfusion were the intra-operative risk factors.After the debridement of hematoma, the clinical outcome showed complete recovery in 2 cases, incomplete recovery in 4 cases, no change in 2 cases. Conclusions： Patients with age of more than 65 years old, revision surgery, operation time of more than 120 minutes, blood loss of more than 600 ml, frozen plasma transfusion may be the risk factors of postoperative lumbar spinal epidural hematoma. After the debridement of hematoma,the neurological function improves in most of the patients but the results was unsatisfactory.