后路椎体间融合术治疗复发性腰椎间盘突出症围手术期并发症及其危险因素

Retrospective analysis of perioperative complications and risk factors of posterior lumbar interbody fusion for recur- rent lumbar disc herniation

目的回顾性总结后路椎体间融合术（posterior lumbar interbody fusion，PLIF）治疗复发性腰椎间盘突出症的围手术期并发症，并分析其相关危险因素。方法2008年1月至2014年12月对71例复发性腰椎间盘突出症患者施行了PLIF手术。收集所有患者的人口学数据、手术资料及并发症情况。通过单因素分析临床因素[年龄、性别、身体质量指数（bodymassindex，BMI）、合并疾病、抽烟状况、复发时间、出血量、手术节段、手术时间]与并发症发生的相关性，将有统计学意义的指标应用多因素Logistic回归方程确定并发症发生的相关危险因素。结果共71例纳入研究，男42例，女29例；年龄19～64岁，平均50．6岁；BMI平均为23．6kg／m2。26例（36．6％）患者出现围手术期并发症33例次，其中5例（7％）患者出现2个及以上并发症，无死亡病例发生。短暂神经功能缺失或神经痛（10例次，14．1％）和硬膜囊撕裂（6例次，8．5％）最常见，其他并发症包括神经根或马尾损伤（3例，4．2％）、浅表或深部感染（5例，7．0％）、泌尿系统感染（5例，7．0％）、呼吸系统并发症（1例）、心血管并发症（1例）、谵妄（1例）。单因素分析结果显示年龄、性别、合并疾病、抽烟与否、手术节段、复发时间、手术时间并不是影响并发症发生的影响因素。多因素Logistic回归分析结果显示BMI（P=0．008）和出血量（P=0．016）与并发症的发生密切相关。结论后路减压融合术治疗复发性椎间盘突最常见的并发症是短暂神经功能缺失、神经痛及硬膜囊撕裂。并发生的发生受多种因素影响，其中BMI和出血量是影响并发症发生的重要因素。

Objective To retrospectively analyze the perioperative complications of posterior lumbar interbody fusion （PLIF） for recurrent lumbar disc herniation and identify potential risk factors that correlate with those complications. Methods All of 71 patients with recurrent lumbar disc herniation were treated surgically with PLIF, discharged from our department between January 2008 and December 2014. Demographic and operation data were collected and perioperative complications were record- ed. We analyzed whether the clinical factors （age, gender, BMI, co-morbidity, smoking, time of recurrence, blood loss, operation segment, operation time） were in correlation with perioperative complication by univariate analysis. Then we integrated the statisti- cally significant indicators into Logistic regression equation to determine the related risk factors for complication. Results The study group consisted of 71 cases, including 42 males and 29 females. The age was 19 to 64 years old with an average of 50.6 years old, and the average BMI was 23.6 kg/m2. 26 cases had perioperative complications, while there were two or more complications in 5 patients, and no mortalities. Neurologic deterioration or neuropathie pain （10 cases, 14.1%） and dural tears （6 cases, 8.5%） were the most common intraoperaitive complications. The other complications included nerve root or cauda equine injury, deep or superficial wound infection, urinary tract infection, respiratory system complication, eardio-vascular com- plication and delirium. Univariate analysis suggested that age, gender, co-morbidity, smoking, time of recurrence, operation segment, operation time were not associated with perioperative complication. The multivariate Logistic regression analysis showed BMI and blood loss were closely related to perioperative complication. Conclusion Complications of posterior spinal fusion surgery for recurrent lumbar disc herniation are affected by many factors. The most common complications are transient neurologie deterioration or neuropathic pain and dural tears. BMI and blood loss are independent risk factors.