老年腰椎管狭窄症患者腰椎内固定手术并发症的临床分析

Clinical Analysis of Complications of Lumbar Spinal Stenosis in Elderly Patients with Lumbar Spinal Stenosis

目的:分析老年腰椎管狭窄症患者腰椎内固定手术后并发症的发生的影响因素,及其发生率,探讨减少手术并发症的相关措施。方法:回顾性分析2013年6月至2017年6月60岁以上腰椎减压固定融合的手术治疗的腰椎管狭窄症患者,分为无并发症组和有并发症。评价手术效果,记录术中及术后3个月内并发症发生情况。分析年龄、体重指数(Body Mass Index,BMI)、病程、合并症、手术节段、手术时间、失血量、住院时间和围手术期并发症的相关性。通过分析结果、查阅文献确定减少并发症的措施。结果:73例患者中总共11例发生并发症,其中3例全身并发症,8例局部并发症。两组比较,发生并发症患者的BMI值大(t=2.177,P=0.038),术前合并症多(χ~2=7.207,P=0.027),手术节段多(χ~2=6.402,P=0.041),手术时间长(t=2.907,P=0.007)、出血量多(t=2.204,P=0.036),住院时间长(t=4.655,P=0.000)。手术节段越多,手术时间越长(F=100. 222,P=0. 000),出血量也随之增多(F=130.050,P=0.000)。两组患者术后3个月ODI评分(t=0.901,P=0.375)和Odom分级比较没有明显差异(U=309.000,P=0.541)。失血量和手术时间(r=0.591,P=0.000)、住院时间呈正性强相关(r=0.517,P=0.003),BMI和失血量呈弱正相关(r=0.374,P=0.038)。结论:并发症发生率与失血量和手术时间呈强相关。通过术中应用氨甲环酸、骨刀椎板切除、双侧同时显露和操作,减少融合节段可以减少手术时间和出血量,有助于减少并发症。

Objective: To analyze the influencing factors and incidence of complications after lumbar internal fixation in elderly patients with lumbar spinal stenosis,and to explore the relevant measures to reduce the complications. Methods: Patients aged 60 years and above with one or more comorbidities operated by multilevel instrumented lumbar fusion in our center between January 2012 and December 2013 were included in the study. Perioperative complications and their incidence were calculated. Age,number of levels fused,operative time,blood loss,and complication rates were correlated with the duration of stay and the incidence of perioperative complications using SPSS software. Measures to reduce complications are determined by these results and by review of literature. Results: Fifty two patients were included in the study (28 females and 24 males) with an average age of 69 years (range 60-84 years). Hypertension was the most common comorbidity followed by diabetes. Spondylolisthesis was the most common indication. Eleven complications were noted with an incidence of 21%. Three were systemic complications which required transfer to Intensive Care Unit. Local complications were incidental durotomy (three),transient root deficits (two),wound infections (one),and persistent radicular pain (two). Operative time and blood loss were significantly higher in patients with complications. Conclusion: The incidence of complications was strongly correlated with blood loss and operation time. The application of tranexamic acid,bone knife laminectomy,bilateral exposure and operation can reduce the operation time and bleeding volume,and help to reduce complications.