Eguchi Yawara, Suzuki Munetaka, Sato Takashi, Yamanaka Hajime, Tamai Hiroshi, Kobayashi Tatsuya, Orita Sumihisa, Suzuki Miyako, Inage Kazuhide, Kanamoto Hirohito, Abe Koki, Norimoto Masaki, Umimura Tomotaka, Aoki Yasuchika, Koda Masao, Furuya Takeo, Nakamura Junichi, Akazawa Tsutomu, Takahashi Kazuhisa, Ohtori Seiji
Department of Orthopaedic Surgery, Shimoshizu National Hospital, Yotsukaido, Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Spine Surg Relat Res. 2019 Jan 25;3(3):244-248. doi: 10.22603/ssrr.2018-0086. eCollection 2019.
To investigate the risk of epidural hematoma after spinous process-splitting laminectomy (SPSL).
A total of 137 cases (mean age, 72.4 years; 68 men) of SPSL were included. Of these, there were instances (3.7%; mean age, 70.5 years; all male) of postoperative development of new neurologic deficit due to epidural hematoma requiring reoperation. The 133 subjects (72.5 years; 64 men) with normal postoperative course were used as controls, and comparisons were made between both groups using chi-squared and Student's -tests. Regarding our investigation of risk factors for epidural hematoma, logistic regression was conducted with presence or absence of hematoma as our primary outcome variable, and age, gender, disease duration, number of laminectomies, which levels were decompressed, blood loss, length of case, drain output, coagulopathy, and whether or not there was an intraoperative dural tear were our explanatory variables.
All cases of hematoma were single-level laminectomies; there was one case of T9-10 and 3 cases of L2-3. In our direct comparison of both groups (hematoma versus control), the proportion of men was significantly higher in the hematoma group (100% versus 48%, p < 0.05); levels decompressed were also significantly higher (p < 0.05) in the hematoma group, and drain outputs were significantly lower (113 mL versus 234 mL, p < 0.05). From our logistic regression analysis, the levels were significantly higher (χ = 15, p = 0.0001) and the drain outputs were smaller (χ = 4.6, p = 0.03) in the hematoma group.
Single-level decompression higher than the L2-3 level and reduced drain output were risk factors for spinal epidural hematoma. With this method of spinous process suturing and reconstruction there is less decompression compared with more conventional methods; therefore, the effect of hematoma may be more pronounced at higher vertebral levels with reduced canal width, and drain failure may also occur with this limited space.
探讨棘突劈开椎板切除术（SPSL）后硬膜外血肿的风险。
共纳入137例SPSL患者（平均年龄72.4岁；男性68例）。其中，有部分病例（3.7%；平均年龄70.5岁；均为男性）术后因硬膜外血肿出现新的神经功能缺损而需要再次手术。将术后病程正常的133例受试者（72.5岁；男性64例）作为对照组，两组间采用卡方检验和t检验进行比较。关于硬膜外血肿危险因素的调查，以是否存在血肿作为主要结局变量进行逻辑回归分析，年龄、性别、病程、椎板切除数量、减压节段、失血量、手术时长、引流量、凝血功能障碍以及术中是否存在硬脊膜撕裂作为解释变量。
所有血肿病例均为单节段椎板切除术；其中T9 - 10节段1例，L2 - 3节段3例。在两组直接比较（血肿组与对照组）中，血肿组男性比例显著更高（100%对48%，p < 0.05）；血肿组减压节段也显著更多（p < 0.05），且引流量显著更少（113 mL对234 mL，p < 0.05）。从逻辑回归分析来看，血肿组减压节段显著更多（χ = 15，p = 0.0001）且引流量更少（χ = 4.6，p = 0.03）。
高于L2 - 3节段的单节段减压和引流量减少是脊髓硬膜外血肿的危险因素。与更传统的方法相比，采用这种棘突缝合和重建方法减压较少；因此，在椎管宽度变窄的较高椎体节段，血肿的影响可能更明显，且在这个有限空间内也可能发生引流失败。
