脊柱侧凸后路三维矫形术围手术期并发症的危险因素及其预防策略

Risk Factors and Prevention Strategies for Perioperative Complications of Posterior Three-dimensional Correction of Scoliosis

目的:评估脊柱侧凸后路三维矫形术并发症的危险因素及其预防策略。方法:本研究纳入2005年10月至2015年1月期间本院骨科所收治的接受脊柱侧凸后路三维矫形术的患者186例。回顾性分析患者的人口学数据、手术资料及并发症的发生情况。通过单因素分析临床因素与并发症发生的相关性,并采用多因素Logistic回归模型分析有统计学意义的指标。另外,回顾性分析预防策略及其临床效果。结果:在186例患者中出现围手术期并发症55例次,其中5例(2.69%)患者术后出现伤口感染,26例(13.98%)术后出现切口延迟愈合,8例(4.30%)术后出现肺部感染,11例(5.91%)术后出现泌尿系感染,5例(2.69%)患者术后发生深静脉血栓。单因素分析结果显示年龄、性别、合并疾病、手术节段、手术时间与并发症的发生无相关性。多因素Logistic回归模型分析结果显示术中出血量是并发症发生的独立危险因素。采用围手术期预防性策略可以降低并发症的发生率。结论:脊柱侧凸后路三维矫形术最常见的并发症是切口延迟愈合和泌尿系感染。并发症的发生受多种因素影响,其中术中出血量是并发症发生的独立危险因素。采用围手术期预防性策略可以降低并发症的发生率。

Objective.. To evaluate the risk factors and prevention strategies of postoperative three-dimensional correction ot scoliosis. Methods： A total of 186 patients underwent three-dimensional correction of scoliosis from January 2014 to February 2015 were included in this study. The demographic data, surgical data and the incidence of complications of the patients were analyzed retrospectively. The correlation between clinical factors and complication was analyzed by univariate analysis, and multivariate logistic regression model was used to analyze the statistically significant indexes. In addition, the preventive strategies and their clinical effects were analyzed retrospectively. Resuits~ Fifty-five patients （2.69 %） had wound infection in 186 patients, and 26 cases （13.980~） had delayed incision after operation. Eight patients （4.30 % ） had pulmonary infection, 11 cases （5.91%） had postoperative urinary tract infection, and 5 cases （2. 69%） had deep vein thrombosis after surgery. Univariate analysis showed that age, sex, combined disease, operative segment, operation time and the occurrence of complications were not related. Multivariate logistic regression analysis showed that intraoperative blood loss was an independent risk factor for complications. The use of perioperative preventive strategies can reduce the incidence of complications. Conclusion： The most common complications of posterior three-dimensional correction of scoliosis are delayed incision healing and urinary tract infection. The incidence of complications is affected by a variety of fac tors, and intraoperative blood loss is an independent risk factor for the occurrence of complications. The perioperative preventive strategies can reduce the incidence of complications.