颈椎前路手术后早期并发症的相关因素分析

Analysis of related factors of early complications after anterior cervical spinal surgery

目的探讨颈椎前路手术后早期并发症的相关因素。方法回顾分析2009-05-2014-07开展的颈椎前路手术110例,其中颈椎骨折、脱位34例,颈椎病44例,颈椎结核17例,颈椎肿瘤15例;采用前路减压植骨融合术37例,前路减压植骨融合+AO钢板内固定25例,前路减压植骨融合+Orion钢板内固定29例,前路减压植骨融合+蝶形钢板内固定19例。手术范围:单节段手术61例,2节段27例,3节段15例,4节段7例。并依据早期并发症发生与否,统计患者的性别、年龄,疾病类型、病程,术前神经功能障碍情况,合并症,麻醉方式,手术方式,手术节段,手术时间,术中出血量等信息作为自变量;以患者术后是否出现早期并发症作为因变量,进行单因素和多因素Logistic回归分析。结果单因素分析发现,疾病类型(x^2=10.782,P=0.013)、神经功能障碍情况(x^2=15.789,P<0.01)以及术前有无合并症(x^2=40.205,P<0.01)、手术方法(x^2=9.819,P=0.02)这4项指标的组间差异有统计学意义(P<0.05),提示这4项指标与颈椎前路手术后早期并发症的发生有关。多因素Logistic回归分析发现,患者的手术方式(β=1.712,S.E.=0.563,P=0.005)与疾病类型(β=1.725,S.E.=0.758,P=0.026)是影响颈椎前路术后早期并发症的独立危险因素。结论颈椎前路手术后出现早期并发症,主要与手术方式和疾病类型有关:行单纯减压植骨融合术的早期并发症发生率偏高,颈椎外伤、肿瘤和结核患者术后可能更易发生早期并发症。

Objective To explore the related factors of early complications after anterior cervical spinal surgery, in order to provide reference for clinical. Methods A retrospective analysis of 110 cases from May 2009 to July 2014 who carried out the anterior cervical surgery were conducted, including cervical fracture and dislocation in 34 cases, 44 cases of cervical disease, 17 cases of cervical tuberculosis, 15 eases of cervical tumor; the anterior decompression and fusion surgery in 37 cases, anterior decompression and interbody fusion ＋AO fixation in 25 cases, anterior decompression the fusion of ＋Orion plate fixation in 29 cases, anterior decompression and bone graft fusion and butterfly plate fixation in 19 cases. Operation range： single segment operation in 61 cases, 2 segments in 27 cases, 3 segments in 15 cases, 4 segments in 7 cases. And on the basis of the early complications or not, age and gender statistics of patients, disease type, disease course, preoperative paralysis, complications, anesthesia, surgical methods, surgical segment, operation time, bleeding volume and other information, as to whether the independent variables; postoperative early complications were as the dependent variable. Univariate and multivariate Logistic regression analysis was conducted. Results Univariate analysis showed that the type of disease （2=10.782, P=0.013）, paralysis （2=15.789, P〈0.01 ） and preoperative complications（2=40.205, P〈0.01）, surgical methods （2=9.819, P=0.02） had statistically significant differences between the groups （P〈O.05）, suggested that the 4 indicators of early complications and after the occurrence of anterior cervical spine surgery. Multivariate Logistic regression analysis showed that surgical patients （g=1.712,S.E.=0.563,P=0.005） and the type of disease （β=1.725,S.E.=0.758,P=0.026） were independent risk factors of early complications after anterior cervical spine surgery. Conclusion Early complications after anterior cervical surgery, mainly related to surgery and the type of disease, early complications underwent decompression and fusion of the high incidence of patients with cervical spine trauma, tumor, tuberculosis may be more prone to early complications.