Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, Liaoning Province, People's Republic of China.
J Orthop Surg Res. 2020 Sep 29;15(1):445. doi: 10.1186/s13018-020-01971-5.
With respect to spinal surgeries, elucidating absolute and relative amount of hidden blood loss (HBL) is of great importance in order to avoid aforementioned potential complications. To evaluate HBL and its possible risk factors among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases.
Between June 2018 and March 2019, 137 consecutive patients with lumbar degenerative disease, who underwent operation with MIS-TLIF technique, were enrolled in this study. The patient's demographic characteristics and blood loss-related parameters were collected, respectively. The Pearson or Spearman correlation analysis was used to investigate an association between patient's characteristics and HBL. Multivariate linear regression analysis was used to confirm independent risk factors of HBL.
A total of 137 patients (86 males and 51 females, age range 19-78 years) were reviewed in our hospital. A substantial amount of HBL (488.4 ± 294.0 ml, 52.5% of TBL) occurred after MIS-TLIF. Multivariate linear regression showed that the age, muscle thickness, the Patients' Society of Anesthesiologists (ASA) classification, patient's blood volume (PBV), total blood loss (TBL), postoperative (i.e., day 2 or 3) hematocrit (Hct), Hct loss, and fibrinogen level were independent risk factors for HBL (P1 = 0.000, P2 = 0.002, P3 = 0.006, P4 = 0.002, P5 = 0.003, P6 = 0.048, P7 = 0.004, P8 = 0.000).
A large amount of HBL was incurred in patients undergoing MIS-TLIF. More importantly, the age, muscle thickness, ASA classification, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen level were independent risk factors for HBL in MIS-TLIF. HBL and its risk factors should be paid more attention to during the perioperative period.
在脊柱手术中，阐明隐性失血量（HBL）的绝对和相对量对于避免上述潜在并发症非常重要。本研究旨在评估微创经椎间孔腰椎体间融合术（MIS-TLIF）治疗腰椎退行性疾病患者的 HBL 及其可能的危险因素。
本研究纳入 2018 年 6 月至 2019 年 3 月期间接受 MIS-TLIF 手术治疗的 137 例腰椎退行性疾病患者。收集患者的人口统计学特征和与失血相关的参数。采用 Pearson 或 Spearman 相关分析探讨患者特征与 HBL 的相关性。采用多元线性回归分析确定 HBL 的独立危险因素。
本研究共纳入 137 例患者（男 86 例，女 51 例；年龄 19-78 岁）。MIS-TLIF 术后发生大量 HBL（488.4±294.0ml，占总出血量的 52.5%）。多元线性回归分析显示，年龄、肌肉厚度、美国麻醉医师协会（ASA）分级、患者血容量（PBV）、总出血量（TBL）、术后第 2 或 3 天的红细胞压积（Hct）、Hct 下降值和纤维蛋白原水平是 HBL 的独立危险因素（P1=0.000，P2=0.002，P3=0.006，P4=0.002，P5=0.003，P6=0.048，P7=0.004，P8=0.000）。
MIS-TLIF 术后患者存在大量 HBL。更重要的是，年龄、肌肉厚度、ASA 分级、PBV、TBL、术后 Hct、Hct 下降值和纤维蛋白原水平是 MIS-TLIF 患者 HBL 的独立危险因素。围手术期应更加关注 HBL 及其危险因素。
