颈椎后路椎板切除融合手术后相关并发症的独立风险因素

Independent risk factors for complications after posterior cervical laminectomy and fusion

目的探讨颈椎后路椎板切除融合术(posterior cervical laminectomy and fusion,PCLF)术后并发症相关的危险因素。方法纳入2015年7月-2019年7月接受PCLF手术的多节段CSM患者196例,观察术后30 d内的并发症发生情况。统计所有患者的人口学资料和围手术期资料,并进行单因素分析和多因素Logistic回归分析,以确定术后并发症的独立预测因素。结果术后30 d内,共发生相关并发症51例,占比26.0%。并发症组和无并发症组患者的行走状态、术前服用阿片类镇痛药构成比和术中失血量、手术时间数据比较,差异均有统计学意义(P<0.05);两组的性别、年龄、吸烟、保险类型、翻修手术、术前ASA分级、合并症、术前其他用药情况和融合椎体数等资料比较,差异均无统计学意义(P>0.05)。经多因素Logistic回归分析,术前服用阿片类镇痛药(OR=5.150)、术中失血量(OR=4.872)、手术时间(OR=5.181)是术后30 d内出现并发症的独立风险因素;独立行走(OR=0.216)则是一项独立保护因素。结论术前服用阿片类镇痛药和术中大量失血、手术时间较长,均明显增加PCLF术后30 d内并发症的发生风险;术前独立步行是降低术后并发症发生率的有利因素。

Objective To explore the risk factors associated with postoperative complications of posterior cervical laminectomy and fusion(PCLF).Methods A total of 196 patients with multi-segment CSM who underwent PCLF surgery from July 2015 to July 2019 were included in this study,and the occurrence of complications within 30 days after surgery was observed.The demographic data and perioperative data of all patients were analyzed,and univariate analysis and multivariate logistic regression analysis were performed to determine the independent predictors of postoperative complications.Results Within 30 days after operation,a total of 51 cases occurred related complications,accounting for 26.0%.There were statistically significant differences in the walking status,the ratio of preoperative opioid analgesics,intraoperative blood loss,and operation time data between the complication group and the non-complication group(P<0.05).The gender,age,smoking,insurance type,revision surgery,preoperative ASA classification,comorbidities,other medications before surgery and number of fusion vertebral bodies had no statistically significant differences between the two groups(P>0.05).Multivariate logistic regression analysis showed that preoperative use of opioid analgesics(OR=5.150),intraoperative blood loss(OR=4.872),operation time(OR=5.181)were independent risk factors for complications within 30 days after surgery.Independent walking(OR=0.216)was an independent protective factor.Conclusion Taking opioid analgesics before surgery,massive intraoperative blood loss,and long operation time can significantly increase the risk of complications within 30 days after PCLF;independent walking before surgery is a favorable factor to reduce the incidence of postoperative complications.