摘要目的 回顾性分析后路腰椎融合手术后并发症的危险因素.方法 回顾性分析2010至2014年中山大学孙逸仙纪念医院脊柱外科行腰椎融合手术的654例患者相关资料.通过单因素卡方检验及ANOVA分别对围手术期伴随疾病及术中相关因素对于手术后并发症进行相关性检验,然后选取P值＜ 0.10的因素进一步进行Logistic回归,以明确术后并发症的独立风险因素.结果 654例患者术后总体的并发症发生率为11.6％(76例次).术后严重并发症包括心肌梗死(2例,0.3％)、深部感染(8例,1.2％)、脓毒血症(2例,0.3％)、神经损伤(8例,1.2％)和再次手术(7例,1.1％);术后轻度并发症包括切口愈合不良(7例,1.1％)、泌尿系统感染(7例,1.1％)、肺部感染(7例,1.1％)、消化道出血(5例,0.8％)、脑脊液漏(10例,1.5％)及其他轻微并发症(9例,1.4％).卡方检验及ANOVA的结果提示,术前肾功能不全(OR=0.135,P=0.002)、术前神经功能障碍(OR=0.101,P=0.000)、ASA评分Ⅲ级以上(OR=1.364,P=0.031)、术中出血量大(F=8.591,P=0.003)、手术时间长(F=16.425,P=0.000)及人工骨植骨(P=0.098)是任一种并发症事件的危险因素.术前肾功能不全(OR=0.096,P=0.000)、术前神经功能障碍(OR=0.159,P=0.000),术中出血量大(F=7.013,P=0.008)、手术时间长(F=12.080,P=0.001)是任一种轻度并发症的危险因素.术前神经功能障碍(OR=0.1 00,P=0.000)、椎间植骨融合(OR=1.566,P=0.006)、后外侧植骨融合(OR=0.578,P=0.021)是任一种严重并发症的危险因素.Logistic回归证实,术前神经功能障碍(OR=12.938,P=0.000)及手术时间长(OR=1.005,P=0.000)是任一种并发症事件的独立危险因素;术前肾功能不全(OR=6.717,P=0.024)、术前神经功能障碍(OR=7.040,P=0.001)及手术时间长(OR-=1.004,P=0.002)是任一种轻度并发症的独立危险因素;术前神经功能障碍(OR=8.446,P=0.001)是任一种严重并发症的独立危险因素,而椎间植骨融合反而是其独立的保护因素(OR=0.394,P=0.047).结论 术前神经功能障碍、肾功能不全、手术时间过长是腰椎融合手术后并发症的独立危险因素;对于存在以上因素的患者,应该更加慎重选择治疗方案,加强围手术期管理,以期减少并发症的发生.

abstractsObjective To analyze the perioperative risk factors of postoperative complications after posterior lumbar fusion operation.Methods The clinical data of 654 patients with posterior lumbar fusion during 2010 and 2014 were retrospectively analyzed.Using x2 test and one-way ANOVA,the predicted risk factors were screened for further Logistic regression.Results The total complication rate was 11.6％ among all 654 patients.The major complications included cardiac infarction,deep infection,sepsis,neurological impairment,and secondary operation.And the minor complications included wound dehiscence,urinary tract infection,pulmonary infection,gastrointestinal bleeding,CSF leakage and others.According to x2 test and one-way ANOVA,renal function insufficiency,preoperative neurological injury,ASA higher than Ⅲ level,intraoperative blood loss,long operation length,and usage of autogenous bone were screened as risk factors of complications.Renal function insufficiency,preoperative neurological injury,intraoperative blood loss,and long operation length were screened as risk factors of minor complications.And male,renal function insufficiency,preoperative neurological injury,intervertebral fusion,and posteriolateral fusion were screened as risk factors of major complications.However,according to Logistic regression,the independent risk factor of complications were preoperative neurological injury and long operation length;independent risk factors of minor complications were renal function insufficiency,preoperative neurological injury and long operation length;and independent risk factor of major complications was preoperative neurological injury.Conclusion Preoperative neurological injury,renal function insufficiency and long operation length are proved to be the risk factors of postoperative complication in lumbar fusion surgery.