Guigui P, Cardinne L, Rillardon L, Morais T, Vuillemin A, Deburge A
Service de Chirurgie Orthopédique, Hôpital Beaujon, 100, boulevard du Général Leclerc, 92110 Clichy, France.
Rev Chir Orthop Reparatrice Appar Mot. 2002 Nov;88(7):669-77.
The main objective of this prospective observational study of a consecutive series of patients was to determine the rate of per- and postoperative complications of surgical treatment of lumbar spinal stenosis. A second objective was to describe these complications and search for factors favoring their occurrence.
All patients who underwent surgical treatment of spinal stenosis without significant spinal deviation in our unit between January 1998 and January 2000 were enrolled in this study. The series thus included 306 patients with at least six months follow-up. Three types of data were recorded before surgery: demographic data including comorbidity, data related to the type of stenosis operated, and data related to the type of procedure (simple release, release with fusion, etc.). A special observation chart was designed to record all complications during the hospital stay and follow-up visits at three, six and twelve months. Four categories of complications were recorded: general complications, early or late infections, early or late mechanical disorders, and neurological complications including meningeal involvement and surgery-related neurological disorders. Univariate analysis was performed to determine the overall rate of complications and the incidence within each category of complications. Multivariate analysis using logistic regression was performed to examine factors favoring occurrence of complications.
The overall rate of complications was 26.5%. The incidence of general, infectious, neurological, and mechanical complications was 13, 4.5, 2.6 and 2% respectively. The incidence of serious complications and/or events requiring reoperation was 12%. Comorbidity, body mass index, operative time, and reoperation were found to favor the occurrence of complications.
The rates of complications reported in the literature have varied greatly. Most have been calculated from retrospective series, making it difficult to compare them with our results. Our work emphasizes the importance of certain favoring factors which should be re-examined in a larger series.
本项针对一系列连续患者的前瞻性观察性研究的主要目标是确定腰椎管狭窄症手术治疗的围手术期及术后并发症发生率。第二个目标是描述这些并发症并寻找促使其发生的因素。
1998年1月至2000年1月期间在本单位接受无明显脊柱侧弯的椎管狭窄症手术治疗的所有患者均纳入本研究。该系列共纳入306例患者，随访时间至少6个月。术前记录三种类型的数据：包括合并症的人口统计学数据、与所施行狭窄类型相关的数据以及与手术方式（单纯减压、减压融合等）相关的数据。设计了一张特殊的观察表来记录住院期间以及术后3个月、6个月和12个月随访时的所有并发症。记录了四类并发症：全身并发症、早发性或迟发性感染、早发性或迟发性机械性障碍以及包括脑膜受累和手术相关神经障碍在内的神经并发症。进行单因素分析以确定并发症的总体发生率以及各并发症类型的发生率。采用逻辑回归进行多因素分析以检验促使并发症发生的因素。
并发症总体发生率为26.5%。全身、感染、神经和机械性并发症的发生率分别为13%、4.5%、2.6%和2%。严重并发症和/或需要再次手术的事件发生率为12%。发现合并症、体重指数、手术时间和再次手术有利于并发症的发生。
文献报道的并发症发生率差异很大。大多数是根据回顾性系列计算得出的，因此难以与我们的结果进行比较。我们的工作强调了某些促成因素的重要性，这些因素应在更大规模的系列研究中重新审视。
