脊柱畸形矫形术后严重并发症危险因素分析

Risk factors of postoperative major complication after spine deformity surgery

目的探讨脊柱畸形矫形手术后严重并发症的危险因素。方法2011年1月至2014年12月首都医科大学附属北京朝阳医院骨科行脊柱畸形矫形手术的患者254例，其中男68例，女186例，平均年龄22．1（3～73）岁。按照是否发生术后严重并发症分为两组：组I29例，术后发生严重并发症；组1I225例，未发生严重并发症。进行单因素分析和多因素Logistic回归分析。结果单因素分析结果显示，29例患者术后发生严重并发症的组I中，患病时间、矫形手术史、术前神经损伤、主弯累及的椎体数目、主弯角度、存在重度后凸、术中截骨、手术时间、手术出血量均大于或长于Ⅱ组；术前肺最大肺活量（MVC）、术后矫形率低于或差于Ⅱ组[（63．5％±23．9％）比（76．7％±21．9％），（53％±23％）比（68％±21％），P〈0．05]。经多因素分析发现，术前神经损伤史（OR=5．976）、病史较长（〉10年，OR=4．095）、MVC实际值／预测值％〈50（OR=7．405）、手术时间〉5h（OR=3．510）、术中截骨（OR=3．472）为脊柱矫形手术术后发生严重并发症的危险因素。结论临床上可预测术后严重并发症的发生。对具有危险因素的患者采取更多的防治措施，以降低术后并发症的发生率。

Objective To analyze risk factors of major complications after spinal deformity surgery. Methods From January 2011 to December 2014, 254 consecutive patients undergone spinal deformity surgery , 68 make and 186 female, average age 22. 1 （3 -73 ） years, were divided into two groups based on if they had major complications after surgery. Univariate and multivariate analysis （ Logistic regression） were used to identify the risk factors. Results Among them, 29 patients had major complications after surgery. Univariate risk factors showed that medical history, scoliosis operation history, preoperative nerve injury, vertebral number of major curve, cobb of major curve, Kyphosis（ 〉 90~ ） , time of operation, operative bleeding and osteotomy of group I were higher or longer than those of group Ⅱ. Maximal voluntary ventilation （ MVC ） and orthopaedic rate of group I were worse than those of group Ⅱ [ （63.5% ± 23.9% ） vs （76. 7%± 21.90 ）, （ 53% ± 23% ） vs （68% ±21% ）, P 〈 0. 05 ]. Logistic regression identified that preoperative nerve injury （ OR = 5. 976 ） , medical history 〉 10 years （ OR = 4. 095 ） , MVC observed/predicted 〈 50 （ OR = 7. 405 ）, time of operation 〉 5 h （ OR = 3.510 ）, osteotomy （OR = 3. 472 ）were final risk factors for major complications. Conclusions Major complications after surgery to treat spinal deformity can be predicted through preoperative nerve injury, medical history, maximal voluntary ventilation observed/predicted, time of operation and osteotomy during the surgery. The patients with these risk factors need more preoperative care and postoperative care to reduce the occurrence of major complications.