经椎间孔和椎板间腰椎内镜术后并发类脊髓高压症的危险因素分析

Risk factor analysis of myeloid hypertension after transforaminal and interlaminar endoscopic lumbar spine surgery

目的探讨经椎间孔和椎板间腰椎内镜术后发生类脊髓高压症的危险因素。方法回顾性分析我院2016年6月至2022年2月接受经椎间孔和椎板间腰椎内镜手术治疗的378例患者的临床资料,根据术后是否发生类脊髓高压症将患者分为并发症组(n=4)和非并发症组(n=374)。记录所有患者发生并发症的潜在影响因素,包括性别、年龄、体质量指数(body mass index,BMI)、手术方式、手术节段、手术时间、术中出血量、术中灌洗量、术中是否脑脊液漏等,分析以上因素组间差异是否具有统计学意义,对差异有统计学意义的影响因素进行Logistic回归分析,从而评价各个影响因素与术后并发类脊髓高压症的相关性。结果378例中有4例术后发生类脊髓高压症,发生率为1.06%。组间比较显示,手术时间[(178.3±29.3)min vs.(105.3±25.5)min]、术中灌洗量[(2806.3±531.5)ml vs.(1537.6±246.8)ml]、术中是否脑脊液漏(100%vs.10.2%)3个影响因素的组间差异有统计学意义(P<0.05)。Logistic回归分析显示上述3个影响因素与类脊髓高压症具有相关性。结论手术时间长、术中灌洗量大、术中发生脑脊液漏是腰椎内镜术后并发类脊髓高压症的独立危险因素,在达到手术目的的前提下,应尽量缩短手术时间,减少术中灌洗量,特别是术中发生脑脊液漏后,应尽快采取必要措施,避免类脊髓高压症的发生。

Objective To investigate the risk factors for myeloid hypertension after transforaminal and interlaminar endoscopic lumbar spine surgery.Methods The clinical data of 378 patients who received transforaminal and interlaminar endoscopic lumbar spine surgery from June 2016 to February 2022 were retrospectively reviewed.All the patients were divided into 2 groups according to whether myeloid hypertension post-operatively occurred:4 patients in Complication Group and 374 in Non-complication Group.Potential factors related with complication were recorded in all the patients,including gender,age,BMI,surgical procedure,surgical level,operation time,intraoperative blood loss,intraoperative irrigation volume,cerebrospinal fluid leakage.The differences above between the 2 groups were analyzed statistically.Logistic regression analysis was applied to evaluate the correlation between significant factors and myeloid hypertension after lumbar full-endoscopy spine surgery.Results Among 378 cases,myeloid hypertension after operation occurred in 4 cases.The incidence of myeloid hypertension was 1.06%.The inter-group comparison indicated statistically significant differences(P<0.05)in operation time[(178.3±29.3)min vs.(105.3±25.5)min],intraoperative irrigation volume[(2806.3±531.5)ml vs.(1537.6±246.8)ml],and cerebrospinal fluid leakage(100%vs.10.2%).Logistic regression analysis showed these 4 statistically significant factors were associated with myeloid hypertension.Conclusions The prolonged operation time,excessive intraoperative irrigation volume,and cerebrospinal fluid leakage are the independent factors influencing myeloid hypertension after endoscopic lumbar spine surgery.Under the premise of achieving the operation goal,we should reduce the operation time and intraoperative irrigation volume.Necessary steps should be taken to avoid myeloid hypertension when intraoperative cerebrospinal fluid leakage occurs.