经椎间孔入路腰椎椎间融合术术后引流量增多的危险因素分析-现代医学

经椎间孔入路腰椎椎间融合术术后引流量增多的危险因素分析

单位：1. 南京鼓楼医院集团宿迁医院骨科, 江苏宿迁 223800;
2. 徐州医科大学附属宿迁医院骨科, 江苏宿迁 223800

分类号：R684

出版年·卷·期（页码）：2024·52·第三期（407-412）

摘要：

目的：探讨经椎间孔入路腰椎椎间融合术(TLIF)术后引流量增多的危险因素。方法：回顾性分析2016年1月至2022年10月收治的218例行TLIF手术治疗患者的临床资料，所有患者术后均常规在切口内放置引流管。以218例患者引流量分布的中位数为临界点将其分为引流量正常组和引流量增多组。收集两组患者的性别、年龄、身体质量指数(BMI)、是否吸烟、是否合并基础疾病、术前美国麻醉医师协会(ASA)分级、手术时间、术中出血量、融合节段数、是否合并术中终板损伤、术后引流管放置时间等临床资料。进行单因素分析后，对阳性结果进行多因素Logistic回归分析以确定TLIF术后引流量增多的危险因素。结果：218例患者术后引流量分布的中位数为460 mL(60~1 220 mL)，其中引流量正常组患者107例(引流量＜460 mL)，引流量增多组患者111例(引流量≥460 mL)。单因素分析结果显示两组患者在性别、BMI、是否合并基础疾病、ASA分级等因素比较差异无统计学意义(P>0.05)。而两组患者在年龄、是否吸烟、融合节段数、是否合并术中终板损伤、术中出血量、手术时间、术后引流管放置时间等因素比较差异有统计学意义(P＜0.05)。多因素Logistic回归分析结果显示高龄(OR=1.264,P=0.001)、吸烟(OR=2.186,P=0.006)、融合节段数多(OR=3.578,P=0.002)、术中终板损伤(OR=3.282,P=0.024)、术后引流管放置时间长(OR=2.429,P=0.007)是TLIF术后引流量增多的独立危险因素。结论：高龄、吸烟、融合节段数多、术中终板损伤、术后引流管放置时间长是TLIF术后引流量增多的独立危险因素。

Objective: To investigate the risk factors forincreased drainage volume after transforaminal lumbar interbody fusion(TLIF).Methods: The clinical data of 218 patients treated with TLIF from January 2016 to October 2022 were retrospectively analyzed. All patients were routinely placed with drainage tube in the incision after surgery. 218 patients were divided into normal drainage volume group and increased drainage volume group with the median of drainage volume distribution as critical point. Gender, age, body mass index(BMI), smoking status,medical history,preoperative American Society of Anesthesiologists(ASA) grade, operative time, intraoperative blood loss, number of fusion segments, intraoperative endplate injury, and postoperative drainage tube placement time were compared between two groups.Univariate analysis was performed, and then multivariate Logistic regression analysis was performed to determine the risk factors for increased drainage volume after TLIF.Results: The median postoperative drainage volume distribution of 218 patients was 460 mL(60-1 220 mL), including 181 patients in the normal drainage volume group(drainage volume <480 mL) and 187 patients in the increased drainage volume group(drainage volume≥480 mL). The results of univariate analysis showed that there were no significant differences in gender, BMI, medical history, and ASA grade between the two groups(P>0.05). There were significant differences in age, smoking status, number of fusion segments, intraoperative endplate injury, intraoperative blood loss, operative time, and postoperative drainage tube placement time(P＜0.05). Multivariate Logistic regression analysis showed that older age(OR=1.264, P=0.001), smoking(OR=2.186, P=0.006), larger number of fusion segments(OR=3.578, P=0.002), intraoperative endplate injury(OR=3.282, P=0.024) and longer placement time of postoperative drainage tube(OR=2.429, P=0.007) were independent risk factors for increased drainage volume after TLIF.Conclusion: This study shows that older age, smoking, larger number of fusion segments, intraoperative endplate injury, and longer placement time of postoperative drainage tube are independent risk factors for increased drainage volume after TLIF.

参考文献：

[1] 汪小军,秦入结,任春朋,等.改良TLIF结合个性减压术与PLIF术治疗腰椎管狭窄症合并腰椎不稳的疗效比较[J].东南大学学报(医学版),2018,37(3):496-501.
[2] GUBIN A V,PRUDNIKOVA O G,SUBRAMANYAM K N,et al.Role of closed drain after multi-level posterior spinal surgery in adults:a randomised open-label superiority trial[J].Eur Spine J,2019,28(1):146-154.
[3] DIAB M,SMUCNY M,DORMANS J P,et al.Use and outcomes of wound drain in spinal fusion for adolescent idiopathic scoliosis[J].Spine(Phila Pa 1976),2012,37(11):966-973.
[4] BLANK J,FLYNN J M,BRONSON W,et al.The use of postoperative subcutaneous closed suction drainage after posterior spinal fusion in adolescents with idiopathic scoliosis[J].J Spinal Disord Tech,2003,16(6):508-512.
[5] KOTIL K.Closed drainage versus non-drainage for single-level lumbar disc surgery:relationship between epidural hematoma and fibrosis[J].Asian Spine J,2016,10(6):1072-1078.
[6] PENNINGTON Z,LUBELSKI D,MOLINA C,et al.Prolonged post-surgical drain retention increases risk for deep wound infection after spine surgery[J].World Neurosurg,2019,130:e846-e853.
[7] LIU J M,DENG H L,CHEN X Y,et al.Risk factors for surgical site infection after posterior lumbar spinal surgery[J].Spine(Phila Pa 1976),2018,43(10):732-737.
[8] BASQUES B A,BOHI D D,GOLINVAUX N S,et al.Factors predictive of increased surgical drain output after anterior cervical discectomy and fusion[J].Spine(Phila Pa 1976),2014,39(9):728-735.
[9] SHI H,WANG X H,ZHU L,et al.Intraoperative endplate injury following transforaminal lumbar interbody fusion[J].World Neurosurg,2022,168:e110-e118.
[10] 王练英,陈仁军.静脉应用氨甲环酸对腰椎后路减压融合内固定术围手术期隐性失血量和疼痛评分的影响[J].现代医学,2022,50(10):1305-1310.
[11] SHI H,HUANG Z H,HUANG Y,et al.Which criterion for wound drain removal is better following posterior 1-level or 2-level lumbar fusion with instrumentation:time driven or output driven?[J].Global Spine J,2023,13(4):1017-1023.
[12] GOSAIN A,DIPIETRO L A.Aging and wound healing[J].World J Surg,2004,28(3):321-326.
[13] MCCUNNIFF P T,YOUNG E S,AHMADINIA K,et al.Smoking is associated with increased blood loss and transfusion use after lumbar spinal surgery[J].Clin Orthop Relat Res,2016,474(4):1019-1025.
[14] YU C C,KADRI O,KADADO A,et al.Intravenous and oral tranexamic acid are equivalent at reducing blood loss in thoracolumbar spinal fusion:a prospective randomized trial[J].Spine(Phila Pa 1976),2019,44(11):755-761.
[15] MOLLERA M,VILLEBRO N,PEDERSEN T,et al.Effect of preoperative smoking intervention on postoperative complications:a randomised clinical trial[J].Lancet,2002,359(9301):114-117.
[16] MALHAM G M,PARKER R M,BLECHER C M,et al.Assessment and classification of subsidence after lateral interbody fusion using serial computed tomography[J].J Neurosurg Spine,2015,23(5):589-597.
[17] FLOYD C T,PADUA R A,OLSON C E.Hemostasis and safety of a novel fibrin dressing versus standard gauze in bleeding cancellous bone in a caprine spine surgery model[J].Spine Deform,2017,5(5):310-313.
[18] SHI H,ZHOU Z M,XU Z Y,et al.Risk factors for increased surgical drain output after transforaminal lumbar interbody fusion[J].World Neurosurg,2021,151:e1044-e1050.
[19] 张坡,王睿,嵇辉,等.腰4/5节段不同类型终板缺损与腰椎间盘退变关系研究[J].现代医学,2023,51(6):818-822.

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