Uehara Masashi, Ikegami Shota, Oba Hiroki, Miyaoka Yoshinari, Kamanaka Takayuki, Hatakenaka Terue, Fukuzawa Takuma, Hayashi Koji, Mimura Tetsuhiko, Takahashi Jun
Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
World Neurosurg. 2023 Apr;172:e679-e683. doi: 10.1016/j.wneu.2023.02.001. Epub 2023 Feb 9.
Wound dehiscence after cervical spine surgery is a well-known complication that can be a challenge for spine surgeons to manage, especially in cases of exposed implants. However, few studies have focused primarily on this phenomenon in cervical spine surgery to date. This investigation sought to determine the frequency of wound dehiscence following posterior cervical spine surgery and identify patient-based risk factors.
The medical data of 405 consecutive patients (290 male and 115 female; mean age: 68.9 years) who underwent posterior cervical spine surgery were retrospectively examined. Logistic regression models were employed to examine the prevalence, characteristics, and risk factors of postoperative wound dehiscence.
We observed that 5.2% of cervical spine surgery patients experienced procedural postoperative wound dehiscence. In comparisons of dehiscence and non-dehiscence groups, significant differences were found for posterior instrumented fusion (81.0% vs. 45.3%; P < 0.01), extended T1 fusion (57.1% vs. 12.8%; P < 0.01), occipitocervical fusion (19.0% vs. 6.2%; P = 0.048), fused intervertebral levels (4.0 vs. 1.5; P < 0.01), surgical time (246 minutes vs. 165 minutes; P < 0.01), blood loss volume (228 mL vs. 148 mL; P = 0.023), and dialysis (14.3% vs. 1.8%; P = 0.011). Multivariate analysis identified extended T1 fusion and dialysis to be significantly associated with wound dehiscence with odds ratios of 5.82 and 10.70, respectively.
The observed frequency of postoperative wound dehiscence in cervical spine surgery was 5.2%. As extended T1 fusion and dialysis may increase the risk of dehiscence after surgery, patients who display such risk factors may require additional observation and care.
颈椎手术后伤口裂开是一种众所周知的并发症，脊柱外科医生在处理时可能面临挑战，尤其是在植入物外露的情况下。然而，迄今为止，很少有研究主要关注颈椎手术中的这一现象。本研究旨在确定颈椎后路手术后伤口裂开的发生率，并识别基于患者的风险因素。
回顾性分析405例连续接受颈椎后路手术患者（男性290例，女性115例；平均年龄：68.9岁）的医疗数据。采用逻辑回归模型分析术后伤口裂开的发生率、特征及风险因素。
我们观察到5.2%的颈椎手术患者术后出现手术伤口裂开。在裂开组与未裂开组的比较中，后路器械融合术（81.0%对45.3%；P<0.01）、T1节段延长融合术（57.1%对12.8%；P<0.01）、枕颈融合术（19.0%对6.2%；P=0.048）、融合的椎间隙水平（4.0对1.5；P<0.01）、手术时间（246分钟对165分钟；P<0.01）、失血量（228 mL对148 mL；P=0.023）以及透析（14.3%对1.8%；P=0.011）存在显著差异。多因素分析确定T1节段延长融合术和透析与伤口裂开显著相关，比值比分别为5.82和10.70。
颈椎手术中观察到的术后伤口裂开发生率为5.2%。由于T1节段延长融合术和透析可能增加术后伤口裂开的风险，存在这些风险因素的患者可能需要额外的观察和护理。
