Wang Hongwei, Yu Hailong, Zhang Ning, Xiang Liangbi
Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China.
Department of Orthopedics, The Second Hospital of Chaoyang, Chaoyang, China.
Neurospine. 2023 Jun;20(2):525-535. doi: 10.14245/ns.2245066.533. Epub 2023 Jun 30.
Studies discussed few risk factors for specific patients, such as duration of disease; or surgical factors, such as duration and time of surgery; or C3 or C7 involvement, which could have led to the formation of hematomas (HTs). To investigate the incidence, risk factors especially the factors mentioned above, and management of postoperative HTs following anterior cervical decompression and fusion (ACF) for degenerative cervical diseases.
Medical records of 1,150 patients who underwent ACF for degenerative cervical diseases at our hospital between 2013 and 2019 were identified and reviewed. Patients were categorized into the HT group (HT group) or normal group (no-HT group). Demographic, surgical and radiographic data were recorded prospectively to identify risk factors for HT.
Postoperative HT was identified in 11 patients, with an incidence rate of 1.0% (11 of 1,150). HT occurred within 24 hours postoperatively in 5 patients (45.5%), while it occurred at an average of 4 days postoperatively in 6 patients (54.5%). Eight patients (72.7%) underwent HT evacuation; all patients were successfully treated and discharged. Smoking history (odds ratio [OR], 5.193; 95% confidence interval [CI], 1.058-25.493; p = 0.042), preoperative thrombin time (TT) value (OR, 1.643; 95% CI, 1.104-2.446; p = 0.014) and antiplatelet therapy (OR, 15.070; 95% CI, 2.663-85.274; p = 0.002) were independent risk factors for HT. Patients with postoperative HT had longer days of first-degree/intensive nursing (p < 0.001) and greater hospitalization costs (p = 0.038).
Smoking history, preoperative TT value and antiplatelet therapy were independent risk factors for postoperative HT following ACF. High-risk patients should be closely monitored through the perioperative period. Postoperative HT in ACF was associated with longer days of first-degree/intensive nursing and more hospitalization costs.
既往研究很少探讨特定患者的风险因素，如疾病持续时间；或手术因素，如手术持续时间和时间；或C3或C7受累情况，这些因素可能导致血肿（HT）形成。本研究旨在调查颈椎前路减压融合术（ACF）治疗退变性颈椎疾病后HT的发生率、风险因素（尤其是上述因素）及处理方法。
回顾性分析2013年至2019年在我院接受ACF治疗退变性颈椎疾病的1150例患者的病历资料。将患者分为HT组和正常组（非HT组）。前瞻性记录患者的人口统计学、手术和影像学资料，以确定HT的风险因素。
11例患者发生术后HT，发生率为1.0%（11/1150）。5例患者（45.5%）在术后24小时内发生HT，6例患者（54.5%）平均在术后4天发生HT。8例患者（72.7%）接受了HT清除术；所有患者均成功治疗并出院。吸烟史（比值比[OR]，5.193；95%置信区间[CI]，1.058 - 25.493；p = 0.042）、术前凝血酶时间（TT）值（OR, 1.643；95% CI，1.104 - 2.446；p = 0.014）和抗血小板治疗（OR，15.070；95% CI，2.663 - 85.274；p = 0.002）是HT的独立危险因素。术后发生HT的患者一级/特级护理天数更长（p < 0.001），住院费用更高（p = 0.038）。
吸烟史、术前TT值和抗血小板治疗是ACF术后HT的独立危险因素。高危患者在围手术期应密切监测。ACF术后HT与一级/特级护理天数延长和住院费用增加有关。
