患者相关因素对单节段经椎间孔腰椎体间融合术隐性和总失血量的影响。

The effects of patient related factors on hidden and total blood loss in single-level open transforaminal lumbar interbody fusion surgery.

机构信息

Clinic of Orthopaedics and Traumatology, Ulus Liv Hospital, İstanbul, Turkey.

Clinic of Orthopaedics and Traumatology, Vadistanbul Liv Hospital, İstanbul, Turkey.

出版信息

Acta Orthop Traumatol Turc. 2022 Jul;56(4):262-267. doi: 10.5152/j.aott.2022.21380.

DOI:10.5152/j.aott.2022.21380

PMID:35943076

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9612666/

Abstract

OBJECTIVE

The aim of this retrospective study was to identify the amount of TBL and HBL and analyse the risk factors using multivariate linear regression analysis during single-level OTLIF surgery.

METHODS

In this study 62 patients (32 male, 30 female, mean age 49.22 ± 13.26) who underwent single-level interbody fusion proce dures by a single surgeon between 2015 and 2021 were included. Retrospectively, relevant statistics regarding body mass index (BMI), American Society of Anesthesiologist Score (ASA), preoperative mean arterial pressure (MAP), and age were gathered. Preoperative MR images were used to assess and measure radiological parameters such as skin-disc distance (SDA), canal area (CA), paravertebral muscle area (PVMA),lumbosacral maximum subcutaneous fat thickness (LSMSF), operation level subcutaneous fat thickness (OPSF) and spi nous process length (SPL).Total blood loss (TBL) was calculated according to Nadler's formula. Hidden blood loss (HBL) was measured by deducting the measured (visible) blood loss from TBL. TBL, HBL and their relationship with preoperative parameters were assessed.

RESULTS

HBL was determined to be significantly higher in older patients (P = 0.012). MAP was seen to have a statistically significant cor relation with operating time (P = 0.002), operative bleeding (P = 0.002), TBL (P = 0.006), and HBL (P = 0.001), and an inverse correlation with postoperative drainage (P = 0.007). The ASA scores were observed to be statistically significantly correlated with TBL (P = 0.001), and HBL (P = 0.001). LSMSF showed a significant correlation with TBL (P = 0.005) and HBL (P = 0.002). OPSF was determined to be correlated with TBL (P = 0.011), HBL (P = 0.009) and length of stay in hospital (P =0.034). SDD was correlated with TBL (P =0.043), and SPL with HBL (P = 0.013). It was shown that age (P =0.012), MAP (P =0.001), ASA (P =0.001), LSMFS (P = 0.002), OPSF (P = 0.009), SPL (P = 0.013) were risk factors for HBL. According to multivariate logistic regression analysis; two anatomical factors LSMSF and SPL were independent risk factors for HBL (P < 0.05).

CONCLUSION

This results of this study have revealed that most patient-related parameters have a significant effect on HBL and TBL.The study has also demonstrated that LSMSF and SPL are independent risk factors for HBL.

LEVEL OF EVIDENCE

Level IV, Therapeutic Study.

摘要

目的

本回顾性研究旨在确定单节段 OTLIF 手术中 TBL 和 HBL 的量，并通过多变量线性回归分析来分析风险因素。

方法

本研究纳入了 2015 年至 2021 年间由同一位外科医生进行的 62 例单节段椎间融合手术的患者（32 名男性，30 名女性，平均年龄 49.22±13.26 岁）。回顾性收集了与体重指数（BMI）、美国麻醉师协会评分（ASA）、术前平均动脉压（MAP）和年龄相关的统计学资料。术前磁共振成像（MRI）用于评估和测量皮肤-椎间盘距离（SDA）、椎管面积（CA）、椎旁肌面积（PVMA）、腰骶部最大皮下脂肪厚度（LSMSF）、手术水平皮下脂肪厚度（OPSF）和棘突长度（SPL）等影像学参数。根据 Nadler 公式计算总失血量（TBL）。通过从 TBL 中减去测量的（可见）失血量来测量隐性失血量（HBL）。评估 TBL、HBL 及其与术前参数的关系。

结果

研究发现，年龄较大的患者 HBL 明显更高（P = 0.012）。MAP 与手术时间（P = 0.002）、手术出血（P = 0.002）、TBL（P = 0.006）和 HBL（P = 0.001）呈统计学显著相关，与术后引流呈统计学显著负相关（P = 0.007）。ASA 评分与 TBL（P = 0.001）和 HBL（P = 0.001）呈统计学显著相关。LSMSF 与 TBL（P = 0.005）和 HBL（P = 0.002）呈显著相关。OPSF 与 TBL（P = 0.011）、HBL（P = 0.009）和住院时间（P = 0.034）相关。SDA 与 TBL（P = 0.043）相关，SPL 与 HBL（P = 0.013）相关。研究表明，年龄（P = 0.012）、MAP（P = 0.001）、ASA（P = 0.001）、LSMFS（P = 0.002）、OPSF（P = 0.009）、SPL（P = 0.013）是 HBL 的危险因素。根据多变量逻辑回归分析；两个解剖学因素 LSMSF 和 SPL 是 HBL 的独立危险因素（P<0.05）。