Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
University of Maryland School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2021 Oct;154:e649-e655. doi: 10.1016/j.wneu.2021.07.107. Epub 2021 Jul 29.
Evaluate if dural tears (DTs) are an indirect risk factor for venous thromboembolic disease through increased recumbency in patients undergoing elective lumbar decompression and instrumented fusion.
This was a retrospective cohort study of consecutive patients undergoing elective lumbar decompression and instrumented fusion at a single institution between 2016 and 2019. Patients were divided into cohorts: those who sustained a dural tear and those who did not. The cohorts were compared using Student's t-test or Wilcoxon Rank Sum for continuous variables and Fisher exact or chi-squared test for nominal variables.
Six-hundred and eleven patients met inclusion criteria, among which 144 patients (23.6%) sustained a DT. The DT cohort tended to be older (63.6 vs. 60.6 years, P = 0.0052) and have more comorbidities (Charlson Comorbidity Index 2.75 vs. 2.35, P = 0.0056). There was no significant difference in the rate of symptomatic deep vein thrombosis (2.1% vs. 2.6%, P = 1.0) or pulmonary embolus (1.4% vs. 1.50%, P = 1.0). Intraoperatively, DT was associated with increased blood loss (754 mL vs. 512 mL, P < 0.0001), operative time (224 vs. 195 minutes, P < 0.0001), and rate of transfusion (19.4% vs. 9.4%, P = 0.0018). Postoperatively, DT was associated with increased time to ambulation (2.6 vs. 1.4 days, P < 0.0001), length of stay (5.8 vs. 4.0 days, P < 0.0001), and rate of discharge to rehab (38.9 vs. 25.3%, P = 0.0021).
While DTs during elective lumbar decompression and instrumentation led to later ambulation and longer hospital stays, the increased recumbency did not significantly increase the rate of symptomatic venous thromboembolic disease.
评估在接受择期腰椎减压和器械融合的患者中，硬脊膜撕裂（DTs）是否通过增加卧床时间成为静脉血栓栓塞疾病的间接危险因素。
这是一项对 2016 年至 2019 年在一家机构接受择期腰椎减压和器械融合的连续患者进行的回顾性队列研究。患者分为两组：发生硬脊膜撕裂的组和未发生硬脊膜撕裂的组。使用学生 t 检验或 Wilcoxon 秩和检验比较连续变量，使用 Fisher 确切检验或卡方检验比较名义变量。
611 名患者符合纳入标准，其中 144 名患者（23.6%）发生了 DT。DT 组患者年龄较大（63.6 岁比 60.6 岁，P=0.0052），合并症较多（Charlson 合并症指数 2.75 比 2.35，P=0.0056）。症状性深静脉血栓形成（2.1%比 2.6%，P=1.0）或肺栓塞（1.4%比 1.50%，P=1.0）的发生率无显著差异。术中，DT 与出血量增加（754 毫升比 512 毫升，P<0.0001）、手术时间延长（224 分钟比 195 分钟，P<0.0001）和输血率增加（19.4%比 9.4%，P=0.0018）相关。术后，DT 与术后下床活动时间延长（2.6 天比 1.4 天，P<0.0001）、住院时间延长（5.8 天比 4.0 天，P<0.0001）和康复出院率降低（38.9%比 25.3%，P=0.0021）相关。
虽然择期腰椎减压和器械固定术中发生的 DT 导致患者下床活动时间延迟和住院时间延长，但增加卧床时间并未显著增加症状性静脉血栓栓塞疾病的发生率。
