Yamada Kentaro, Abe Yuichiro, Satoh Shigenobu, Yanagibashi Yasushi, Hyakumachi Takahiko, Masuda Takeshi
From the Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Hokkaido, Japan.
Spine (Phila Pa 1976). 2015 Jul 1;40(13):1046-52. doi: 10.1097/BRS.0000000000000876.
Matched case-control study.
To identify factors other than a multilevel procedure that increase the risk of symptomatic postoperative spinal epidural hematoma (SEH).
Postoperative SEH is a potentially devastating complication of spinal surgery. Previous studies that reported risk factors for postoperative SEH all identified a multilevel procedure as a risk factor, but the other risk factors remain unclear.
Patients who developed postoperative SEH requiring surgical evacuation were identified from database. Each patient was matched with 3 controls who underwent spinal decompression at the same number of levels in the same part of the spine by the same surgeon during the preceding or following year. Multiple logistic regression analysis was performed to identify the risk factors for postoperative SEH to obtain adjusted odds ratios with 95% confidence intervals. Clinical outcomes after evacuation were investigated separately divided with or without severe paralysis or time until the second surgery.
Postoperative SEH evacuation was performed after 32 of 8250 (0.39%) spinal decompression procedures. The incidence was significantly higher after thoracic procedures (2.41%) than after cervical (0.21%) or lumbar (0.39%) procedures. Multivariate analysis identified a 50 mm Hg or greater increase in systolic blood pressure after extubation (adjusted odds ratio: 3.22, 95% confidence interval: 1.22-8.51) and higher body mass index (adjusted odds ratio 1.15, 95% confidence interval: 1.01-1.31) as risk factors. Among 14 patients with severe paralysis due to postoperative SEH, those who underwent evacuation within 24 hours of the onset had a significantly better improvement in clinical outcome and Frankel grade than did those after 24 hours.
A 50 mm Hg or greater increase in systolic blood pressure after extubation and high body mass index were identified as risk factors for SEH. Appropriate blood pressure control especially at the end of surgery is important for the prevention of postoperative SEH, particularly in obese patients.
配对病例对照研究。
确定除多级手术外增加症状性术后脊髓硬膜外血肿（SEH）风险的因素。
术后SEH是脊柱手术潜在的毁灭性并发症。先前报道术后SEH危险因素的研究均将多级手术确定为危险因素，但其他危险因素仍不明确。
从数据库中识别出发生需要手术清除的术后SEH的患者。每位患者与3名对照匹配，这些对照在之前或之后的一年中由同一位外科医生在脊柱同一部位进行相同节段的脊柱减压手术。进行多因素逻辑回归分析以确定术后SEH的危险因素，以获得调整后的比值比及95%置信区间。分别根据有无严重瘫痪或至二次手术的时间对清除后的临床结果进行调查。
在8250例脊柱减压手术中有32例（0.39%）进行了术后SEH清除。胸椎手术后的发生率（2.41%）显著高于颈椎（0.21%）或腰椎（0.39%）手术后。多因素分析确定拔管后收缩压升高50 mmHg或更多（调整后的比值比：3.22，95%置信区间：1.22 - 8.51）和较高的体重指数（调整后的比值比1.15，95%置信区间：1.01 - 1.31）为危险因素。在14例因术后SEH导致严重瘫痪的患者中，发病后24小时内进行清除的患者临床结果和Frankel分级的改善明显优于24小时后进行清除的患者。
拔管后收缩压升高50 mmHg或更多及高体重指数被确定为SEH的危险因素。适当控制血压，尤其是在手术结束时，对预防术后SEH很重要，特别是对肥胖患者。
3级
