经椎弓根截骨矫形治疗僵硬性脊柱侧凸手术出血量的影响因素分析

Blood Loss In Pedicle Subtraction Osteotomy Surgery for Rigid Scoliosis

目的分析经椎弓根截骨矫形手术治疗僵硬性脊柱侧凸手术出血量的影响因素。方法对我院自2010年1月至2016年9月103例脊柱后路经椎弓根截骨矫形术治疗的僵硬性脊柱侧凸患者进行回顾性分析。记录患者性别、年龄、术前身高、体重、身体质量指数(body mass index,BMI)、脊柱侧凸的类型(本研究中主要有先天性和特发性)、术前冠状位主弯Cobb角、侧弯矫正率、是否行胸廓成形术、是否有椎管内畸形、融合的节段、椎弓根螺钉的数量以及术前血红蛋白、血小板总数(platelet,PLT)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、国际标准化比值(international normalized ratio,INR)。采用多元线性回归的方法分析这些因素对出血量的影响。利用Pearson相关分析研究手术时间与手术出血量的相关性。结果经椎弓根截骨矫形手术平均出血量(2 311.1±1 123.1)mL(700~6 500 mL)。多元线性回归分析表明年龄、脊柱侧凸类型、椎弓根螺钉数量、术前冠状位主弯Cobb角是手术出血量的影响因素。根据结果建立回归方程如下:t=-1 562.8+42.6A+629.0B+78.8C+9.9D,其中T指出血量(mL),A指年龄(岁),B指侧凸类型(特发性=0,先天性=1),C指椎弓根螺钉数量,D指术前冠状位主弯Cobb角。Pearson相关分析显示手术时间与手术出血量为正相关,相关系数为0.463,P<0.000 1。结论年龄、脊柱侧凸类型、椎弓根螺钉数量、术前冠状位主弯Cobb角是手术出血量的影响因素,根据这些因素可以预测经椎弓根截骨矫形手术的出血量。手术时间与手术出血量为正相关,采取措施缩短手术时间以减少手术的出血量。

Objective To identify the predictors of intraoperative blood loss in pedicle subtraction osteotomy（PSO）surgery for rigid scoliosis.Methods Data of 103 patients treated with PSO surgery for rigid scoliois by a single surgeon from January 2010 to September 2016 were retrospectively analyzed.Sex,age,preoperative height,preoperative weight,BMI,scoliosis type,preoperative Cobb angle,correction rate on Cobb angle,rib resection,intraspinal anomalies,fused levels,surgical procedures,the number of pedicle screws,preoperative laboratory examination（hemoglobin,platelet count,PT,APTT,and INR）were recorded and analyzed with a multivariable linear stepwise regression to develop a predictive model of blood loss.Pearson＇s correlation was also calculated between operation time and blood loss.ResultsIntraoperative blood loss was（2 311.1±1 123.1）mL（range,700 to 6 500 mL）,operation time was positively correlated to blood loss（Pearson＇s correlation 0.463,P〈0.000 1）.Multivariate linear regression identified age,scoliosis type,the number of pedicle screws,preoperative Cobb angle as predictors of increased blood loss.The following formula was developed to predict blood loss during PSO surgery for rigid scoliosis：t=-1 562.8＋42.6 A＋629.0 B＋78.8 C＋9.9 D.T was Blood loss（mL）,A wasage（year）,B was scoliosis type（AIS=0,congenital scoliosi=1）,C was number of pedicle screws,D waspreoperative Cobb angle of main coronal curve（degree）.Conclusion Age,scoliosis type,the number of pedicle screws,preoperative Cobb angle of main coronal curve are the predictors of blood loss,and a formula has been developed to predict the blood loss.Surgeons can use this model to predict blood loss while making small adjustments.Operation time is positively correlated with blood loss,measures should be taken to reduce the operation time,then avoid massive blood loss in PSO surgery for rigid scoliosis.