老年腰椎间盘突出症患者椎间融合术后深静脉血栓形成的临床特点及影响因素分析

Analysis of clinical characteristics and influencing factors of deep venous thrombosis after lumbar interbody fusion in elderly patients with lumbar disc herniation

目的探讨老年腰椎间盘突出症患者腰椎椎体间融合术后深静脉血栓(deep venous thrombosis,DVT)形成的临床特点及影响因素。方法选取2013年1月至2017年11月本院收治的118例行腰椎椎体间融合术的老年腰椎间盘突出症患者为研究对象,根据术后双下肢彩色多普勒超声检查结果将其分为DVT组(22例)和非DVT组(96例),比较两组患者的临床资料,采用多因素Logistic回归分析探讨DVT的影响因素。结果 DVT组患者血栓均位于小腿远端,其中20例(90.9%)位于肌间静脉,其余2例(9.1%)位于胫后静脉。所有合并DVT的患者均给予低分子肝素等抗凝,期间均未出现出血事件,末次复查时均未发现血栓,无一例出现肺栓塞、死亡,所有患者均康复。多因素Logistic回归分析显示,年龄越大、体质指数(body mass index,BMI)越高、术前凝血4项的异常数为2~4项均为DVT发生的独立危险因素(P_均<0.05)。结论老年腰椎间盘突出症患者腰椎椎体间融合术后DVT的发生率较高,年龄越大、BMI越高、术前凝血4项异常数为2~4项者DVT的发生风险更高,临床应加强对此类患者的综合防控。

Objective To analyze the clinical characteristics and influencing factors of deep venous thrombosis （DVT） after lumbar interbody fusion in elderly patients with lumbar disc herniation. Method 118 elderly patients with lumbar disc herniation who underwent lumbar interbody fusion from January 2013 to November 2017 were enrolled in this study, and divided into D VT group （n = 22） and non-DVT group （n = 96） according to the result of postoperator color Doppler ultrasound examination of both lower limbs. Clinical data were compared between the two groups, and multivariate Logistic regression analysis was performed to screen out the independent fnfluencing factors of DVT. Result In the DVT group, all the yhrombus were located in the distal leg, 20 patients （90.9%） were located in intermuscular vein and the other 2 patients （9.1%） were located in the posterior tibial vein. All patients with DVT were treated with low molecular weight heparin and other anticoagulant treatments, and there was no hemorrhagic event occurred during the period. No thrombus in the last review, and no one occurred with pulmonary embolism and died. All patients recovered. Multivariate Logistic regression analysis showed that the older the age, the higher the body mass index （BMI）, and the 2 - 4 abnormalities of preoperative coagulation were independent factors affecting the occurrence ofDVT （P,ll 〈 0.05）. Conclusion The incidence of DVT in elderly patients with lumbar disc herniation was relatively higher after lumbar interbody fusion. The older the age, the higher the BMI, and the abnormal items of four blood coagulation indicators 2 - 4, the risk of DVT is higher. So comprehensive prevention and control should be strengthened for this kind of patients.