Department of Orthopedic Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan.
Spine (Phila Pa 1976). 2018 Sep 1;43(17):1169-1175. doi: 10.1097/BRS.0000000000002577.
This was a single-institute retrospective study.
To evaluate postoperative complications in dialysis-dependent patients undergoing elective cervical and lumbar decompression surgery.
Spinal surgery in dialysis-dependent patients is very challenging due to the high risk of serious postoperative complications and mortality associated with their fragile general condition. However, the outcome of decompression surgery alone has not been evaluated in such patients.
An electronic medical record review showed that 338 and 615 patients had undergone cervical and lumbar spine posterior decompression, respectively. Among them, 48 and 42, respectively were dialysis-dependent patients. Postoperative complications were compared between dialysis-dependent and non-dialysis-dependent patients.
Among patients who underwent cervical decompression, the rate of perioperative blood transfusion in dialysis-dependent patients (14.6%) was significantly higher than that in non-dialysis-dependent patients (0.7%). No severe complications or mortality occurred in association with cervical decompression. The incidence of postoperative complications in dialysis-dependent patients (6.3%) was not significantly different from that in non-dialysis-dependent patients (4.1%). Among patients who underwent lumbar decompression, the rate of perioperative transfusion in dialysis-dependent patients (11.9%) was also significantly higher than that in non-dialysis-dependent patients (0.7%). With respect to severe complications among patients who underwent lumbar decompression, cerebral hemorrhage occurred in one dialysis-dependent patient, and no mortality occurred. The incidence of postoperative complications in dialysis-dependent patients (9.2%) was not significantly different from that in non-dialysis-dependent patients (6.8%).
Among patients who underwent posterior decompression alone for cervical or lumbar lesions, the rate of perioperative blood transfusion was significantly higher in dialysis-dependent than in non-dialysis-dependent patients. However, the postoperative rates of severe complications and mortality were not significantly different between the two groups. Therefore, decompression surgery alone is considered a rational surgical method with less invasiveness for dialysis-dependent patients with a fragile general condition.
这是一项单中心回顾性研究。
评估行择期颈椎和腰椎减压手术的依赖透析患者的术后并发症。
由于依赖透析患者的一般状况脆弱，术后严重并发症和死亡率高，因此脊柱手术极具挑战性。然而，尚未对此类患者单独进行减压手术的结果进行评估。
电子病历回顾显示，分别有 338 例和 615 例患者接受了颈椎和腰椎后路减压术，其中分别有 48 例和 42 例为依赖透析患者。比较了依赖透析和非依赖透析患者之间的术后并发症。
在接受颈椎减压术的患者中，依赖透析患者（14.6%）围手术期输血的发生率明显高于非依赖透析患者（0.7%）。颈椎减压术未发生严重并发症或死亡。依赖透析患者（6.3%）的术后并发症发生率与非依赖透析患者（4.1%）无显著差异。在接受腰椎减压术的患者中，依赖透析患者（11.9%）围手术期输血的发生率也明显高于非依赖透析患者（0.7%）。在接受腰椎减压术的患者中，有一例依赖透析患者发生脑出血，无死亡病例。依赖透析患者（9.2%）的术后并发症发生率与非依赖透析患者（6.8%）无显著差异。
在仅行颈椎或腰椎病变后路减压术的患者中，依赖透析患者围手术期输血的发生率明显高于非依赖透析患者。然而，两组患者的严重并发症和死亡率无显著差异。因此，对于一般状况脆弱的依赖透析患者，单独进行减压手术被认为是一种微创且合理的手术方法。
3。
