腰椎手术后并发硬膜外血肿的处理措施及危险因素分析

Treatment of epidural hematoma after lumbar surgery and analysis of risk factors

目的探讨腰椎手术后并发硬膜外血肿的处理措施和转归,以及与此并发症相关的危险因素。方法研究统计了2011-07-2016-03我院行腰椎手术的603例患者,其中发现有症状的硬膜外血肿9例,均予以血肿清除手术治疗,术中、术后予以甲强龙静脉滴注治疗。将此9例患者作为血肿组;另按1:5的比例自603例患者中,选择45例术后无硬膜外血肿发生者作为对照组,进行相关因素的单因素分析和多因素Logistic回归分析。结果 9例患者术后随访1年以上,其中8例神经功能有良好恢复(5例恢复至D级,3例恢复至E级),仅1例未恢复。单因素分析显示,年龄、是否为翻修手术、手术时间、术中出血量、是否输注冰冻血浆,在两组间有统计学差异(P<0.05);进一步以多因素Logistic回归分析证实,翻修手术、术中出血量>600 ml、手术时间>120min、年龄>65岁、输注冰冻血浆,均为独立的危险因素之一(P<0.05)。结论:腰椎手术后硬膜外血肿予以急诊血肿清除手术联合糖皮质激素治疗,可取得较好疗效;年龄偏高、手术时间长、术中出血量多、输注冰冻血浆和翻修手术,均为引起该并发症的危险因素之一。

Objective To investigate the treatment and prognosis of epidural hematoma after lumbar surgery and the risk factors associated with this complication. Methods From July 2011 to March 2016, 603 patients who received lumbar spine surgery in our hospital were analyzed, including9 cases of epidural hematoma and were given hematoma removal surgery, methylprednisolone was intravenously infused intraoperation and postoperation. These 9 patients were selected as hematoma group. According to the ratio of 1：5, the other 45 cases without postoperative epidural hematoma from603 patients were selected as control group. Logistic regression analysis of single factor analysis and multi factor related factors was performed. Results Nine patients were followed up for more than 1 year. Among them, 8 cases recovered well（5 cases recovered to grade D, 3 cases recovered to grade E）, only 1 case did not recover. Univariate analysis showed that age, whether received revision surgery,operative time, intraoperative bleeding, transfusion of fresh frozen plasma between two groups had significant differences（P〈0.05）. Further multivariate Logistic regression analysis showed that the revision surgery, intraoperative bleeding volume 600 ml, operation time 120 min, age 65 years,infusion of fresh frozen plasma were independent risk factors（P〈0.05）. Conclusion The emergency evacuation of hematoma combined with glucocorticoid in the treatment of lumbar epidural hematoma after surgery can obtain good curative effect. High age, long operation time, large amount of bleeding,transfusion of frozen plasma and revision surgery are risk factors of the complication.